Booneville Chiropractic Clinic, P.a. | |
105b N 2nd St Booneville MS 38829-3207 | |
(662) 728-7414 | |
(662) 728-4163 |
Full Name | Booneville Chiropractic Clinic, P.a. |
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Speciality | Clinic/Center |
Location | 105b N 2nd St, Booneville, Mississippi |
Authorized Official Name and Position | Derrick Roy Blythe (PRESIDENT) |
Authorized Official Contact | 6627287414 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Booneville Chiropractic Clinic, P.a. 105b N 2nd St Booneville MS 38829-3207 Ph: (662) 728-7414 | Booneville Chiropractic Clinic, P.a. 105b N 2nd St Booneville MS 38829-3207 Ph: (662) 728-7414 |
NPI Number | 1154697910 |
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Provider Enumeration Date | 03/27/2012 |
Last Update Date | 03/27/2012 |
Medicare PECOS PAC ID | 0648431676 |
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Medicare Enrollment ID | O20120418000293 |
Identifier | Type | State | Issuer |
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1154697910 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 885 (Mississippi) | Primary |
Provider Name | Derrick R Blythe |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1851473227 PECOS PAC ID: 6507888088 Enrollment ID: I20051227000538 |
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