| Back & Neck Pain Clinic Dr L C Huddleston | |
|
6500 Old Canton Rd Ridgeland MS 39157-1313 | |
| (601) 956-0010 | |
| Not Available |
| Full Name | Back & Neck Pain Clinic Dr L C Huddleston |
|---|---|
| Speciality | Clinic/Center |
| Location | 6500 Old Canton Rd, Ridgeland, Mississippi |
| Authorized Official Name and Position | Leo C Huddleston (OWNER) |
| Authorized Official Contact | 6019530010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Back & Neck Pain Clinic Dr L C Huddleston 6500 Old Canton Rd Ridgeland MS 39157-1313 Ph: (601) 956-0010 | Back & Neck Pain Clinic Dr L C Huddleston 6500 Old Canton Rd Ridgeland MS 39157-1313 Ph: (601) 956-0010 |
| NPI Number | 1255693602 |
|---|---|
| Provider Enumeration Date | 06/12/2012 |
| Last Update Date | 06/13/2012 |
| Medicare PECOS PAC ID | 3072777564 |
|---|---|
| Medicare Enrollment ID | O20120613000459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255693602 | NPI | - | NPPES |
| 00115050 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 624 (Mississippi) | Primary |
| Provider Name | Leo C Huddleston |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1609976810 PECOS PAC ID: 8022272541 Enrollment ID: I20120613000744 |
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