Provider Demographics
NPI:1750563953
Name:CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PAAP
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:601-267-3996
Mailing Address - Street 1:226 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4016
Mailing Address - Country:US
Mailing Address - Phone:601-267-3996
Mailing Address - Fax:601-267-9431
Practice Address - Street 1:226 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4016
Practice Address - Country:US
Practice Address - Phone:601-267-3996
Practice Address - Fax:601-267-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00950500Medicaid
MS00950500Medicaid
MS1073661591Medicare NSC