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General NPI Number Information
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NPI Number | 1831671502
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Entity Type | Organization
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Legal Business Name | BAROUSSE CHIROPRACTIC
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 603 W CANAL ST
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City | PICAYUNE
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State | MS
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Zip | 39466-3916
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Country | US
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Telephone | 330-310-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 E LAKESHORE DR
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City | CARRIERE
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State | MS
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Zip | 39426-7804
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Country | US
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Telephone | 330-310-2020
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Fax |
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Authorized Official
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Title or Position | STAFF
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Name | JOSHUA D BAROUSSE
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Credential |
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Telephone | 330-310-2020
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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 | 1292
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License Number State | MS
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