# HWY 63 MEDICAL AND CHIROPRACTIC CENTER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134370828
- **Authorized official:** DR. VANCE RAY WARDEN D.C. (CHIROPRACTOR)
- **Authorized official phone:** (228) 588-0188

## Contact information

- **Practice address:** 19621 HWY 63, MOSS POINT, MS 39562
- **Practice address phone:** (228) 588-0188
- **Practice address fax:** (228) 588-9184
- **Mailing address:** PO BOX 901, HURLEY, MS 39555-0901
- **Mailing address phone:** (228) 588-0188
- **Mailing address fax:** (228) 588-9184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 987 | MS | Yes |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 10/01/2008
- **Last updated:** 03/25/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00123522 | — | MS |
| 01 | — | 587618900C | BLUE CROSS BLUE SHIELD | MS |