Provider Demographics
NPI:1689862526
Name:GULF COAST PHYSICAL MEDICINE HEALTH AND REHABILIATATION INC
Entity Type:Organization
Organization Name:GULF COAST PHYSICAL MEDICINE HEALTH AND REHABILIATATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-875-6943
Mailing Address - Street 1:2418 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3112
Mailing Address - Country:US
Mailing Address - Phone:228-875-6943
Mailing Address - Fax:228-875-9682
Practice Address - Street 1:2418 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3112
Practice Address - Country:US
Practice Address - Phone:228-875-6943
Practice Address - Fax:228-875-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty