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General NPI Number Information
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NPI Number | 1649646027
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Entity Type | Organization
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Legal Business Name | NORTHEAST CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 575 HIGHWAY 51
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City | RIDGELAND
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State | MS
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Zip | 39157-2593
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Country | US
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Telephone | 601-856-2383
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Fax | 601-856-3955
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Provider Business Mailing Address
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Address Line | 575 HIGHWAY 51
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City | RIDGELAND
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State | MS
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Zip | 39157-2593
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Country | US
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Telephone | 601-856-2383
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Fax | 601-856-3955
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELISA GAMBLE
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Credential |
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Telephone | 601-856-2383
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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 | 655
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License Number State | MS
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