Healthcare Provider Details

I. General information

NPI: 1750454880
Provider Name (Legal Business Name): POPLARVILLE FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 HIGHWAY 26 W
POPLARVILLE MS
39470-7467
US

IV. Provider business mailing address

859 HIGHWAY 26 W
POPLARVILLE MS
39470-7467
US

V. Phone/Fax

Practice location:
  • Phone: 601-795-0211
  • Fax: 601-795-2177
Mailing address:
  • Phone: 601-795-0211
  • Fax: 601-795-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1287
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1004
License Number StateMS

VIII. Authorized Official

Name: DR. KELVIE D CULPEPPER
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 601-795-0211