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General NPI Number Information
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NPI Number | 1134370828
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Entity Type | Organization
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Legal Business Name | HWY 63 MEDICAL AND CHIROPRACTIC CENTER, P.A.
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 19621 HWY 63
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City | MOSS POINT
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State | MS
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Zip | 39562
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Country | US
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Telephone | 228-588-0188
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Fax | 228-588-9184
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Provider Business Mailing Address
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Address Line | PO BOX 901
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City | HURLEY
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State | MS
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Zip | 39555-0901
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Country | US
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Telephone | 228-588-0188
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Fax | 228-588-9184
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. VANCE RAY WARDEN
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Credential | D.C.
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Telephone | 228-588-0188
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 987
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License Number State | MS
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