Provider Demographics
NPI:1629487913
Name:BRUMFIELD, JUSTIN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:BRUMFIELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:THOMAS
Other - Last Name:BRUMFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1080 RIVER OAKS DR STE B103
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7602
Mailing Address - Country:US
Mailing Address - Phone:601-291-8362
Mailing Address - Fax:601-586-8400
Practice Address - Street 1:1080 RIVER OAKS DR STE B103
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7602
Practice Address - Country:US
Practice Address - Phone:601-291-8362
Practice Address - Fax:601-586-8400
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor