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General NPI Number Information
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NPI Number | 1447494950
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Entity Type | Organization
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Legal Business Name | VICTORY CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 315 HIGHWAY 90
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City | GAUTIER
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State | MS
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Zip | 39553-6340
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Country | US
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Telephone | 228-497-9907
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Fax | 228-497-9917
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Provider Business Mailing Address
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Address Line | PO BOX 760
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City | GAUTIER
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State | MS
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Zip | 39553-0760
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Country | US
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Telephone | 228-497-9907
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Fax | 228-497-9917
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JAMES D VICTORY
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Credential | DC
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Telephone | 228-497-9907
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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 | 980
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License Number State | MS
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