Provider Demographics
NPI:1609951847
Name:EMMANUEL RIDGE CHIROPRACTIC SERVICES, INC.
Entity Type:Organization
Organization Name:EMMANUEL RIDGE CHIROPRACTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EZEM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CM,CLNC
Authorized Official - Phone:601-845-3544
Mailing Address - Street 1:2990 HIGHWAY 49 S STE P
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9523
Mailing Address - Country:US
Mailing Address - Phone:601-845-3544
Mailing Address - Fax:601-845-3636
Practice Address - Street 1:4801 N STATE ST STE 116
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4825
Practice Address - Country:US
Practice Address - Phone:601-845-3544
Practice Address - Fax:601-845-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty