=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558032383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MUSCLE AND JOINT CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2021
-----------------------------------------------------
Last Update Date | 04/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 NW PLAZA DR
-----------------------------------------------------
City | SENATOBIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-689-0030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 NW PLAZA DR
-----------------------------------------------------
City | SENATOBIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-689-0030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CALEB MARSTON ALFORD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 662-301-8341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------