Provider Demographics
NPI:1912380528
Name:MID SOUTH CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MID SOUTH CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASPRACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-371-1523
Mailing Address - Street 1:6942 AUTUMN OAKS DR
Mailing Address - Street 2:A
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6942 AUTUMN OAKS DR
Practice Address - Street 2:A
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9379
Practice Address - Country:US
Practice Address - Phone:662-890-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty