Provider Demographics
NPI:1265588297
Name:NETHERLAND ENTERPRISES, INC.
Entity type:Organization
Organization Name:NETHERLAND ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:NETHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-399-2902
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-0270
Mailing Address - Country:US
Mailing Address - Phone:601-399-2902
Mailing Address - Fax:601-776-3512
Practice Address - Street 1:1309B HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2652
Practice Address - Country:US
Practice Address - Phone:601-399-2902
Practice Address - Fax:601-776-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS426964976BOtherBLUE CROSS
MS426964976DOtherBLUE CROSS
MS00120050Medicaid
MS00120050Medicaid