=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992267215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSSOW CLINIC OF OCEAN SPRINGS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2019
-----------------------------------------------------
Last Update Date | 06/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2725 BIENVILLE BLVD
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-872-7111
-----------------------------------------------------
Fax | 228-872-4060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2725 BIENVILLE BLVD
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-872-7111
-----------------------------------------------------
Fax | 228-872-4060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | WILLIAM N ROSSOW
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 228-872-7111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------