Back Room
Organization Active NPI Chiropractor · Gulfport, MS
NPI 1386905412 · NPPES record last updated Jun 13, 2012
Key facts
- NPI
- 1386905412
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1162 (MS)
- Legal business name
- BACK ROOM
- Practice address
- 15312 Dedeaux Rd
Suite a
Gulfport, MS 39503-3123 - Phone
- (228) 331-2035
- NPI assigned
- Jun 5, 2012
- Organization subpart
- No
Authorized official
- Name
- Katanya Ford, D.C.
- Title
- Chiropractor
- Phone
- (228) 331-2035
National Provider Directory
Locations
15312 Dedeaux Rd
Ste A
Gulfport, MS 39503
Phone (228) 331-2035
16197 Landon Rd
#B
Gulfport, MS 39503
Phone (228) 331-2035
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 1162 | MS | Yes |
Addresses
Primary practice location
15312 Dedeaux Rd
Suite a
Gulfport, MS 39503-3123
Mailing address
15312 Dedeaux Rd
Suite a
Gulfport, MS 39503-3123
Phone (228) 331-2035
Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.