Provider Demographics
NPI:1154608792
Name:GIUST CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:GIUST CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GIUST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-833-8100
Mailing Address - Street 1:880 BROOKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2642
Mailing Address - Country:US
Mailing Address - Phone:601-833-8100
Mailing Address - Fax:601-833-3377
Practice Address - Street 1:880 BROOKWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2642
Practice Address - Country:US
Practice Address - Phone:601-833-8100
Practice Address - Fax:601-833-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS284586898AOtherBLUE SHIELD 1500 ID
MS00115776Medicaid
MS284586898AOtherBLUE SHIELD 1500 ID
MS350000169Medicare PIN