Provider Demographics
NPI:1891906582
Name:GASKIN FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:GASKIN FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-619-7122
Mailing Address - Street 1:3425 PEMBERTON SQUARE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5574
Mailing Address - Country:US
Mailing Address - Phone:601-619-7122
Mailing Address - Fax:
Practice Address - Street 1:3425 PEMBERTON SQUARE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5574
Practice Address - Country:US
Practice Address - Phone:601-619-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty