| 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. |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 03/27/2012 |
| Last Update Date | 03/27/2012 |
| Medicare PECOS PAC ID | 0648431676 |
|---|---|
| Medicare Enrollment ID | O20120418000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154697910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 885 (Mississippi) | Primary |
| Provider Name | Derrick R Blythe |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1851473227 PECOS PAC ID: 6507888088 Enrollment ID: I20051227000538 |
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