Provider Demographics
NPI:1528578523
Name:FAMILY WELLNESS & CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY WELLNESS & CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHRONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-954-2669
Mailing Address - Street 1:214 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2712
Mailing Address - Country:US
Mailing Address - Phone:601-884-0557
Mailing Address - Fax:601-623-9311
Practice Address - Street 1:214 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2712
Practice Address - Country:US
Practice Address - Phone:601-884-0557
Practice Address - Fax:601-623-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty