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General NPI Number Information
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NPI Number | 1790158293
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Entity Type | Organization
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Legal Business Name | JBCHIRO1 LLC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 11516 LAMEY BRIDGE RD SUITE E
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City | DIBERVILLE
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State | MS
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Zip | 39540-2725
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Country | US
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Telephone | 228-207-6427
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Fax | 228-207-6428
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Provider Business Mailing Address
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Address Line | 11516 LAMEY BRIDGE RD SUITE E
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City | DIBERVILLE
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State | MS
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Zip | 39540-2725
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Country | US
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Telephone | 228-207-6427
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Fax | 228-207-6428
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN BAMBAN
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Credential | DC
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Telephone | 228-207-6427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 1179
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License Number State | MS
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