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General NPI Number Information
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NPI Number | 1720473986
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC WELLNESS CENTRE, PLLC
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 354 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1610
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Country | US
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Telephone | 662-470-4615
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Fax | 662-470-4619
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Provider Business Mailing Address
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Address Line | 354 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1610
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Country | US
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Telephone | 662-470-4615
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Fax | 662-470-4619
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. JUSTIN MORRIS
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Credential | D.C.
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Telephone | 662-470-4615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 1234
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License Number State | MS
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