Provider Demographics
NPI:1831435262
Name:EAGLE'S POINTE CLINIC OF CHIROPRACTIC LLC
Entity type:Organization
Organization Name:EAGLE'S POINTE CLINIC OF CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACRESHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ESSEX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-951-1908
Mailing Address - Street 1:116 BRECKENRIDGE DR
Mailing Address - Street 2:APT 103
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5910 U S HIGHWAY 49
Practice Address - Street 2:SUITE 15
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7585
Practice Address - Country:US
Practice Address - Phone:601-951-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1198111N00000X
MS1194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty