Provider Demographics
NPI:1538332465
Name:EADY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:EADY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BUDDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-469-3030
Mailing Address - Street 1:3819 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39336-6207
Mailing Address - Country:US
Mailing Address - Phone:601-469-3030
Mailing Address - Fax:601-469-2522
Practice Address - Street 1:500 E THIRD ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4224
Practice Address - Country:US
Practice Address - Phone:601-469-3030
Practice Address - Fax:601-469-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016141Medicaid