Provider Demographics
NPI:1700022951
Name:LOCOCO HEALTH AND WELLNESS INC
Entity Type:Organization
Organization Name:LOCOCO HEALTH AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOCOCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-392-5543
Mailing Address - Street 1:4242 POPPS FERRY RD STE A
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-2391
Mailing Address - Country:US
Mailing Address - Phone:228-392-5543
Mailing Address - Fax:228-392-5541
Practice Address - Street 1:4242 POPPS FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2391
Practice Address - Country:US
Practice Address - Phone:228-392-5543
Practice Address - Fax:228-392-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512G700432Medicare PIN