Provider Demographics
NPI:1831671502
Name:BAROUSSE CHIROPRACTIC
Entity Type:Organization
Organization Name:BAROUSSE CHIROPRACTIC
Other - Org Name:JOSHUA BAROUSSE
Other - Org Type:Other Name
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAROUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-310-2020
Mailing Address - Street 1:1846 E LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-7804
Mailing Address - Country:US
Mailing Address - Phone:330-310-2020
Mailing Address - Fax:
Practice Address - Street 1:603 W CANAL ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3916
Practice Address - Country:US
Practice Address - Phone:330-310-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty