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General NPI Number Information
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NPI Number | 1811249667
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC OF THE SOUTH, PLLC
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 1029 HIGHWAY 51 STE. F2
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City | MADISON
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State | MS
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Zip | 39110-6603
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Country | US
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Telephone | 601-605-0903
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Fax | 601-510-9415
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Provider Business Mailing Address
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Address Line | 1029 HIGHWAY 51 STE. F2
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City | MADISON
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State | MS
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Zip | 39110-6603
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Country | US
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Telephone | 601-605-0903
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Fax | 601-510-9415
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Authorized Official
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Title or Position | DR./OWNER
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Name | DR. BRANDON SLOANE FORTINBERRY
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Credential | D.C.
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Telephone | 601-605-0903
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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 | 1189
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License Number State | MS
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