Provider Demographics
NPI:1457371395
Name:MOBLEY, CHARLES SHERWOOD (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SHERWOOD
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BROOKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2640
Mailing Address - Country:US
Mailing Address - Phone:601-835-1155
Mailing Address - Fax:601-835-1777
Practice Address - Street 1:710 BROOKWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2640
Practice Address - Country:US
Practice Address - Phone:601-835-1155
Practice Address - Fax:601-835-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0859OtherMS STATE , DOCTOR OF CHIR
MSU30041Medicare UPIN