MEDICARE: GULF COAST PHYSICAL MEDICINE HEALTH AND REHABILIATATION 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

General Provider Information

NPI Number	:	1689862526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST PHYSICAL MEDICINE HEALTH AND REHABILIATATION INC

Provider Business Mailing Address
First Line	:	2418 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3112
Country	:	US
Telephone Number	:	228-875-6943
Fax Number	:	228-875-9682

Provider Business Practice Location Address
First Line	:	2418 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3112
Country	:	US
Telephone Number	:	228-875-6943
Fax Number	:	228-875-9682

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD HOUSTON JENKINS
Credential	:	DC
Telephone Number	:	228-875-6943

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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