=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770766495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RATHBURN CHIROPRACTICCLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 10/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 HIGHWAY 80 E
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39056-5123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-924-4647
-----------------------------------------------------
Fax | 601-926-4799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 612 HIGHWAY 80 E
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39056-5123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-924-4647
-----------------------------------------------------
Fax | 601-926-4799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. ALAN N RATHBURN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 601-924-4647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 734
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------