Provider Demographics
NPI:1275957714
Name:GRENADA FAMILY CHIROPRACTIC,INC
Entity Type:Organization
Organization Name:GRENADA FAMILY CHIROPRACTIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-226-8071
Mailing Address - Street 1:30 SUNSET LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4508
Mailing Address - Country:US
Mailing Address - Phone:662-226-8071
Mailing Address - Fax:662-226-8072
Practice Address - Street 1:30 SUNSET LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4508
Practice Address - Country:US
Practice Address - Phone:662-226-8071
Practice Address - Fax:662-226-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty