Provider Demographics
NPI:1750454880
Name:POPLARVILLE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:POPLARVILLE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KELVIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-795-0211
Mailing Address - Street 1:859 HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-7467
Mailing Address - Country:US
Mailing Address - Phone:601-795-0211
Mailing Address - Fax:601-795-2177
Practice Address - Street 1:859 HIGHWAY 26 W
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-7467
Practice Address - Country:US
Practice Address - Phone:601-795-0211
Practice Address - Fax:601-795-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1004111N00000X
LA1287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124156Medicaid
U85147Medicare UPIN