Provider Demographics
NPI:1376882050
Name:DESOTO COUNTY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DESOTO COUNTY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHADWICK
Authorized Official - Last Name:HALL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:901-338-3886
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-0175
Mailing Address - Country:US
Mailing Address - Phone:662-393-4848
Mailing Address - Fax:662-393-4858
Practice Address - Street 1:1134 CHURCH RD W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7144
Practice Address - Country:US
Practice Address - Phone:662-393-4848
Practice Address - Fax:662-393-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center