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General NPI Number Information
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NPI Number | 1619108131
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Entity Type | Organization
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Legal Business Name | JACKSON COUNTY CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 8820 HWY 613
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City | ESCATAWPA
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State | MS
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Zip | 39552-0656
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Country | US
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Telephone | 228-475-0676
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Fax | 228-475-0678
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Provider Business Mailing Address
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Address Line | PO BOX 656
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City | ESCATAWPA
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State | MS
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Zip | 39552
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Country | US
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Telephone | 228-475-0676
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Fax | 228-475-0678
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Authorized Official
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Title or Position | OWNER
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Name | RHONDA K BRANHAM
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Credential |
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Telephone | 228-475-0676
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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 |
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License Number State |
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