Provider Demographics
NPI:1578660627
Name:WEBB, W R (DC)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:R
Last Name:WEBB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0005235223OtherAETNA
MS00115214Medicaid
MS4430039OtherUNITED HEALTHCARE
MS00115214Medicaid
MS302I355557Medicare PIN