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General NPI Number Information
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NPI Number | 1831435262
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Entity Type | Organization
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Legal Business Name | EAGLE'S POINTE CLINIC OF CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 5910 U S HIGHWAY 49 SUITE 15
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City | HATTIESBURG
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State | MS
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Zip | 39401-7585
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Country | US
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Telephone | 601-951-1908
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Fax |
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Provider Business Mailing Address
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Address Line | 116 BRECKENRIDGE DR APT 103
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City | HATTIESBURG
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State | MS
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Zip | 39402-3503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. LACRESHA NICOLE ESSEX
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Credential | D.C.
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Telephone | 601-951-1908
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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 | 1198
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1194
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License Number State | MS
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