Healthcare Provider Details

I. General information

NPI: 1801079249
Provider Name (Legal Business Name): PROFESSIONAL REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAIN ST.
PURVIS MS
39475
US

IV. Provider business mailing address

PO BOX 1863
PURVIS MS
39475-1863
US

V. Phone/Fax

Practice location:
  • Phone: 601-794-0081
  • Fax: 601-794-0083
Mailing address:
  • Phone: 601-794-0081
  • Fax: 601-794-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number998
License Number StateMS

VIII. Authorized Official

Name: DR. JOHN ROBERT ACORD JR.
Title or Position: DOCTOR
Credential: DC
Phone: 601-794-0081