Provider Demographics
NPI:1306877493
Name:HORN LAKE CHIROPRACTIC CENTRE, INC.
Entity type:Organization
Organization Name:HORN LAKE CHIROPRACTIC CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MINKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-342-5368
Mailing Address - Street 1:3400 GOODMAN RD W
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1174
Mailing Address - Country:US
Mailing Address - Phone:662-342-5368
Mailing Address - Fax:662-342-7980
Practice Address - Street 1:3400 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1174
Practice Address - Country:US
Practice Address - Phone:662-342-5368
Practice Address - Fax:662-342-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02633062Medicaid