Provider Demographics
NPI:1063567204
Name:CHIROPRACTIC CENTER OF SALTILLO
Entity type:Organization
Organization Name:CHIROPRACTIC CENTER OF SALTILLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SERENA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-869-9907
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:115 TOWN CREEK DR.
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-1058
Mailing Address - Country:US
Mailing Address - Phone:662-869-9907
Mailing Address - Fax:662-869-9908
Practice Address - Street 1:115 TOWN CREEK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-1058
Practice Address - Country:US
Practice Address - Phone:662-869-9907
Practice Address - Fax:662-869-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty