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General NPI Number Information
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NPI Number | 1285059824
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Entity Type | Organization
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Legal Business Name | PASCAGOULA CLINIC OF CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 421 DELMAS AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-4136
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Country | US
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Telephone | 228-205-3985
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Fax | 228-205-3987
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Provider Business Mailing Address
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Address Line | 421 DELMAS AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-4136
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Country | US
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Telephone | 228-205-3985
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Fax | 228-205-3987
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW BARTLETT
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Credential | D.C.
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Telephone | 228-219-4035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1216
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License Number State | MS
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