Provider Demographics
NPI:1326159294
Name:CROSSROADS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-286-2225
Mailing Address - Street 1:1801 S HARPER RD
Mailing Address - Street 2:SUITE 8C BOX 22
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6768
Mailing Address - Country:US
Mailing Address - Phone:662-286-2225
Mailing Address - Fax:662-286-2125
Practice Address - Street 1:1801 S HARPER RD
Practice Address - Street 2:SUITE 8C BOX 22
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6768
Practice Address - Country:US
Practice Address - Phone:662-286-2225
Practice Address - Fax:662-286-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty