Southern Chiropractic of Douglas, Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR008807 Issued in GA

Legal business name

SOUTHERN CHIROPRACTIC OF DOUGLAS, INC.

Doing business as

Southern Chiropractic of Douglas

Practice address

506 Ashley St W
Douglas, GA 31533-2308

Phone

(912) 389-0042

NPI assigned

Oct 6, 2017

Last updated

Oct 6, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Joshua Brett Mizell, DCNPI 1417249343

Title

Owner/Chiropractor

Phone

(912) 389-0042

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southern Chiropractic of Douglas Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

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, and the practitioner matching its NPPES authorized official.

• Joshua Brett Mizell, D.C.

  • Chiropractor
  • Douglas, GA
  • NPI 1417249343
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507248000000",
    "number": "1538679394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 ASHLEY ST W",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332308",
            "telephone_number": "912-389-0042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 ASHLEY ST W",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332308",
            "telephone_number": "912-389-0042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CHIROPRACTIC OF DOUGLAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-06",
        "last_updated": "2017-10-06",
        "status": "A",
        "authorized_official_last_name": "MIZELL",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "BRETT",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "912-389-0042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "CHIR008807",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Chiropractic of Douglas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Douglas, GA
• Providers in Douglas, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; 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.