Organization Name: | CEDAR LAKE CHIROPRACTIC INC. |
NPI Number: | 1598000309 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JARRETT DALE JOHNSON (PRESIDENT/DOCTOR) |
Mailing Address: | 935 Cedar Lake Rd Biloxi |
State: | MS US |
Postal Code: | 395322128 |
Phone Number: | 2283924000 |
Fax Number: | 2283924001 |
NPI Enumeration Date: | 12/05/2012 |
NPI Last Update Date: | 12/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 1052 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |