Provider Demographics
NPI:1710062641
Name:MASSEY, JR., REN (DC)
Entity Type:Individual
Prefix:DR
First Name:REN
Middle Name:
Last Name:MASSEY, JR.
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HWY 45 ALT. S.
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773
Mailing Address - Country:US
Mailing Address - Phone:662-494-1500
Mailing Address - Fax:662-494-7825
Practice Address - Street 1:1004 HWY 45 ALT. S.
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773
Practice Address - Country:US
Practice Address - Phone:662-494-1500
Practice Address - Fax:662-494-7825
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor