Provider Demographics
NPI:1639260375
Name:NORTH BILOXI CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:NORTH BILOXI CHIROPRACTIC CLINIC PA
Other - Org Name:ADVANCED CHIROPRACTIC HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERND
Authorized Official - Middle Name:KLAUS
Authorized Official - Last Name:BISMARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-861-3645
Mailing Address - Street 1:15105 LEMOYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5201
Mailing Address - Country:US
Mailing Address - Phone:228-392-8616
Mailing Address - Fax:228-392-1278
Practice Address - Street 1:15105 LEMOYNE BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5201
Practice Address - Country:US
Practice Address - Phone:228-392-8616
Practice Address - Fax:228-392-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07324075Medicaid
MS07324075Medicaid
MSC03361Medicare ID - Type UnspecifiedMC GROUP #