=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801079249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL REHABILITATION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2007
-----------------------------------------------------
Last Update Date | 12/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 MAIN ST.
-----------------------------------------------------
City | PURVIS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-794-0081
-----------------------------------------------------
Fax | 601-794-0083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1863
-----------------------------------------------------
City | PURVIS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39475-1863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-794-0081
-----------------------------------------------------
Fax | 601-794-0083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. JOHN ROBERT ACORD JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 601-794-0081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 998
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------