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General NPI Number Information
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NPI Number | 1629116322
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Entity Type | Organization
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Legal Business Name | PEAVY CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 2409 MAMIE ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-7345
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Country | US
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Telephone | 601-582-3343
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Fax | 601-583-6655
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Provider Business Mailing Address
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Address Line | 2409 MAMIE ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-7345
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Country | US
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Telephone | 601-582-3343
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Fax | 601-583-6655
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Authorized Official
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Title or Position | SEC-TRES
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Name | JAN C PEAVY
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Credential |
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Telephone | 601-268-9093
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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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