Provider Demographics
NPI:1700065018
Name:FOXWORTH, RAYMOND A JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:FOXWORTH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2470 FLOWOOD DR
Mailing Address - Street 2:STE 125
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9019
Mailing Address - Country:US
Mailing Address - Phone:601-932-9201
Mailing Address - Fax:601-932-4962
Practice Address - Street 1:2470 FLOWOOD DR
Practice Address - Street 2:STE 125
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9019
Practice Address - Country:US
Practice Address - Phone:601-932-9201
Practice Address - Fax:601-932-4962
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117752Medicaid
MST21064Medicare UPIN
MS350000298Medicare PIN