Provider Demographics
NPI:1518445444
Name:MID SOUTH CHIROPRACTIC OF HORN LAKE PLLC
Entity Type:Organization
Organization Name:MID SOUTH CHIROPRACTIC OF HORN LAKE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPRACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-890-0012
Mailing Address - Street 1:2085 GOODMAN RD W STE 80
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2085 GOODMAN RD W STE 80
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1416
Practice Address - Country:US
Practice Address - Phone:662-890-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty