Provider Demographics
NPI:1275718249
Name:CHIROPRACTIC HEALTH CENTER., PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRECIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-327-8232
Mailing Address - Street 1:613 18TH AVE N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-2237
Mailing Address - Country:US
Mailing Address - Phone:662-327-8232
Mailing Address - Fax:662-328-6794
Practice Address - Street 1:613 18TH AVE N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-2237
Practice Address - Country:US
Practice Address - Phone:662-327-8232
Practice Address - Fax:662-328-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02511Medicare PIN