Provider Demographics
NPI:1467651240
Name:W.R. WEBB, CHIROPRACTOR
Entity Type:Organization
Organization Name:W.R. WEBB, CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-684-2683
Mailing Address - Street 1:134 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3620
Mailing Address - Country:US
Mailing Address - Phone:601-684-2683
Mailing Address - Fax:601-684-6759
Practice Address - Street 1:134 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3620
Practice Address - Country:US
Practice Address - Phone:601-684-2683
Practice Address - Fax:601-684-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS350000243OtherC02487
MS350000243Medicare PIN