MEDICARE: JERNIGAN CHIROPRACTIC CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1275701781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERNIGAN CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	2045 E PASS RD STE B
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3761
Country	:	US
Telephone Number	:	228-896-7574
Fax Number	:	228-896-7579

Provider Business Practice Location Address
First Line	:	2045 E PASS RD STE B
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3761
Country	:	US
Telephone Number	:	228-896-7574
Fax Number	:	228-896-7579

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JEREMY TODD JERNIGAN
Credential	:	D.C.
Telephone Number	:	228-896-7574

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	05/20/2025

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