Southern Regional Chiropractic and Rehabilitation Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1221 Issued in MS

Legal business name

SOUTHERN REGIONAL CHIROPRACTIC AND REHABILITATION CENTER

Practice address

11505 Cinema Dr Ste 7
Diberville, MS 39540

Phone

(228) 365-0449

Fax

(228) 365-2314

NPI assigned

Dec 26, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Susan Lee Keenum

Title

Owner

Phone

(228) 860-5027

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bernard Joseph Keenum, D.C.

  • Chiropractor
  • Diberville, MS
  • NPI 1760654925
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531180800000",
    "number": "1134635360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11505 CINEMA DR STE 7",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395409703",
            "telephone_number": "228-365-0449",
            "fax_number": "228-365-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11505 CINEMA DR STE 7",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "39540",
            "telephone_number": "228-365-0449",
            "fax_number": "228-365-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN REGIONAL CHIROPRACTIC AND REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-26",
        "last_updated": "2018-07-10",
        "status": "A",
        "authorized_official_last_name": "KEENUM",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-860-5027",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MS",
            "license": "1221",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "901566",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cayla Switzer, NP-C

• Chiropractor in Diberville, MS
• Providers in Diberville, MS by specialty
• Chiropractor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.