=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962739623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRETT FAMILY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2009
-----------------------------------------------------
Last Update Date | 08/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5719 HIGHWAY 25 SUITE 5
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-7105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-919-2800
-----------------------------------------------------
Fax | 601-919-2900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5719 HIGHWAY 25 SUITE 5
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-7105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-919-2800
-----------------------------------------------------
Fax | 601-919-2900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS ALBERT GARRETT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 601-919-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 910
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------