Provider Demographics
NPI:1801079249
Name:PROFESSIONAL REHABILITATION SERVICES
Entity type:Organization
Organization Name:PROFESSIONAL REHABILITATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ACORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:601-794-0081
Mailing Address - Street 1:PO BOX 1863
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-1863
Mailing Address - Country:US
Mailing Address - Phone:601-794-0081
Mailing Address - Fax:601-794-0083
Practice Address - Street 1:105 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475
Practice Address - Country:US
Practice Address - Phone:601-794-0081
Practice Address - Fax:601-794-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015049Medicaid
MS09015049Medicaid