Provider Demographics
NPI:1710756804
Name:WALTERS PEAVY CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:WALTERS PEAVY CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-408-6080
Mailing Address - Street 1:2409 MAMIE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7345
Mailing Address - Country:US
Mailing Address - Phone:601-582-3343
Mailing Address - Fax:601-583-6655
Practice Address - Street 1:2409 MAMIE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7345
Practice Address - Country:US
Practice Address - Phone:601-582-3343
Practice Address - Fax:601-583-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty