Provider Demographics
NPI:1275957714
Name:GRENADA FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:GRENADA FAMILY CHIROPRACTIC INC
Other - Org Name:GRENADA FAMILY CHIROPRACTIC INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-303-9830
Mailing Address - Street 1:1360 SUNSET DR STE 3C
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-2857
Mailing Address - Country:US
Mailing Address - Phone:662-226-8071
Mailing Address - Fax:662-226-8072
Practice Address - Street 1:1360 SUNSET DR STE 3C
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-2857
Practice Address - Country:US
Practice Address - Phone:662-226-8071
Practice Address - Fax:662-226-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty