Provider Demographics
NPI:1417041252
Name:ACORD, JOHN ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:ACORD
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1863
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475
Mailing Address - Country:US
Mailing Address - Phone:601-794-0081
Mailing Address - Fax:601-794-0083
Practice Address - Street 1:105 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475
Practice Address - Country:US
Practice Address - Phone:601-794-0081
Practice Address - Fax:601-794-0083
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015049Medicaid
MS09015049Medicaid
MS350000261Medicare ID - Type Unspecified