Provider Demographics
NPI:1568402329
Name:RIVER CITY CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:RIVER CITY CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-636-8771
Mailing Address - Street 1:919 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-2751
Mailing Address - Country:US
Mailing Address - Phone:601-636-8771
Mailing Address - Fax:601-634-1004
Practice Address - Street 1:919 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2751
Practice Address - Country:US
Practice Address - Phone:601-636-8771
Practice Address - Fax:601-634-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81985Medicare UPIN