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General NPI Number Information
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NPI Number | 1275957714
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Entity Type | Organization
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Legal Business Name | GRENADA FAMILY CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1360 SUNSET DR STE 3C
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City | GRENADA
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State | MS
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Zip | 38901-2857
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Country | US
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Telephone | 662-226-8071
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Fax | 662-226-8072
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Provider Business Mailing Address
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Address Line | 1360 SUNSET DR STE 3C
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City | GRENADA
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State | MS
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Zip | 38901-2857
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Country | US
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Telephone | 662-226-8071
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Fax | 662-226-8072
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | FELICIA FAYE POE
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Credential | D.C
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Telephone | 662-303-9830
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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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