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General NPI Number Information
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NPI Number | 1609948397
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Entity Type | Organization
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Legal Business Name | SHUTTLEWORTH CHIROPRACTIC CENTRE PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 665 EAST PASS RD STE 3
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City | GULFPORT
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State | MS
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Zip | 39507
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Country | US
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Telephone | 228-896-3002
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Fax | 228-897-1417
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Provider Business Mailing Address
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Address Line | 665 EAST PASS RD STE 3
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City | GULFPORT
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State | MS
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Zip | 39507
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Country | US
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Telephone | 228-896-3002
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Fax | 228-897-1417
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MARK R SHUTTLEWORTH
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Credential | DC
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Telephone | 228-896-3002
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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 | 0753
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License Number State | MS
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