Provider Demographics
NPI:1679978324
Name:MIDSOUTH CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MIDSOUTH CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-925-1196
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0785
Mailing Address - Country:US
Mailing Address - Phone:731-925-2225
Mailing Address - Fax:731-925-2226
Practice Address - Street 1:635 WATER ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2442
Practice Address - Country:US
Practice Address - Phone:731-925-2225
Practice Address - Fax:731-925-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty