Provider Demographics
NPI:1780197939
Name:HEALTHY YOU CHIROPRACTIC AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:HEALTHY YOU CHIROPRACTIC AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-203-2932
Mailing Address - Street 1:411 BRIARWOOD DR STE 401
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3058
Mailing Address - Country:US
Mailing Address - Phone:601-203-2932
Mailing Address - Fax:769-218-0578
Practice Address - Street 1:411 BRIARWOOD DR STE 401
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3058
Practice Address - Country:US
Practice Address - Phone:601-203-2932
Practice Address - Fax:769-218-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05756238Medicaid