Provider Demographics
NPI:1275701781
Name:JERNIGAN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:JERNIGAN CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-896-7574
Mailing Address - Street 1:2045 E PASS RD STE B
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3761
Mailing Address - Country:US
Mailing Address - Phone:228-896-7574
Mailing Address - Fax:228-896-7579
Practice Address - Street 1:2045 E PASS RD STE B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3761
Practice Address - Country:US
Practice Address - Phone:228-896-7574
Practice Address - Fax:228-896-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSV01453Medicare UPIN