Provider Demographics
NPI:1962620385
Name:LADNER CHIROPRACTIC PC
Entity type:Organization
Organization Name:LADNER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:228-255-8099
Mailing Address - Street 1:28284 HIGHWAY 603
Mailing Address - Street 2:
Mailing Address - City:PERKINSTON
Mailing Address - State:MS
Mailing Address - Zip Code:39573-3793
Mailing Address - Country:US
Mailing Address - Phone:228-255-8099
Mailing Address - Fax:228-255-8098
Practice Address - Street 1:28284 HIGHWAY 603
Practice Address - Street 2:
Practice Address - City:PERKINSTON
Practice Address - State:MS
Practice Address - Zip Code:39573-3793
Practice Address - Country:US
Practice Address - Phone:228-255-8099
Practice Address - Fax:228-255-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04154238Medicaid
MS03533331Medicaid
MSV06916Medicare UPIN