Provider Demographics
NPI:1033545165
Name:SPINE CARE NETWORK CHIROPRACTIC SERVICES, PA
Entity Type:Organization
Organization Name:SPINE CARE NETWORK CHIROPRACTIC SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-875-3555
Mailing Address - Street 1:4 DOCTORS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5721
Mailing Address - Country:US
Mailing Address - Phone:228-875-3555
Mailing Address - Fax:228-818-2934
Practice Address - Street 1:4 DOCTORS DR
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5721
Practice Address - Country:US
Practice Address - Phone:228-875-3555
Practice Address - Fax:228-818-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty