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General NPI Number Information
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NPI Number | 1013460815
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Entity Type | Organization
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Legal Business Name | MIND, BODY & SOUL CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 1224 MACKINAW AVE APT. 1C
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City | CALUMET CITY
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State | IL
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Zip | 60409-5724
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Country | US
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Telephone | 773-972-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 MACKINAW AVE APT. 1C
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City | CALUMET CITY
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State | IL
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Zip | 60409-5724
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Country | US
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Telephone | 773-972-9038
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | DR. FELICIA L BURSE
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Credential | D.C.
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Telephone | 773-972-9038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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