=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255590881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FINK CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 06/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 1/2 SECOND ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39429-2978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-736-5031
-----------------------------------------------------
Fax | 601-736-5031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 1/2 SECOND ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39429-2978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-736-5031
-----------------------------------------------------
Fax | 601-736-5031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HOLLY RENA'E FINK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 601-736-5031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 793
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------