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General NPI Number Information
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NPI Number | 1215445903
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Entity Type | Organization
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Legal Business Name | PICAYUNE CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 403 MEMORIAL BLVD
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City | PICAYUNE
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State | MS
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Zip | 39466-5545
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Country | US
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Telephone | 601-799-2225
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Fax | 601-799-4333
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Provider Business Mailing Address
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Address Line | 403 MEMORIAL BLVD
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City | PICAYUNE
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State | MS
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Zip | 39466-5545
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Country | US
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Telephone | 601-799-2225
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Fax | 601-799-4333
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MICHAEL VARNADO
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Credential | DC
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Telephone | 601-799-2225
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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 | 1237
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License Number State | MS
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