Provider Demographics
NPI:1083999130
Name:FORD, KATANYA D (DC)
Entity Type:Individual
Prefix:DR
First Name:KATANYA
Middle Name:D
Last Name:FORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3182
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-3182
Mailing Address - Country:US
Mailing Address - Phone:228-331-2035
Mailing Address - Fax:228-831-0807
Practice Address - Street 1:1243 28TH ST STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-6203
Practice Address - Country:US
Practice Address - Phone:228-357-5585
Practice Address - Fax:228-357-5655
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor