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General NPI Number Information
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NPI Number | 1598232514
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Entity Type | Organization
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Legal Business Name | EMBODY INSTITUTE OF FUNCTIONAL HEALTH
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 10150 WEHIE CAMP RD
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City | PICAYUNE
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State | MS
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Zip | 39466-9701
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Country | US
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Telephone | 228-229-9544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440442
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City | KENNESAW
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State | GA
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Zip | 30160-9508
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Country | US
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Telephone | 228-229-9544
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. HALIE ELCHOS
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Credential |
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Telephone | 228-229-9544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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