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Organization
SOUTHERN REGIONAL CHIROPRACTIC AND REHABILITATION CENTER
Active
Organization
SOUTHERN REGIONAL CHIROPRACTIC AND REHABILITATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN LEE KEENUM (OWNER)
(228) 860-5027
Entity
Organization
Contact information
Practice address
11505 CINEMA DR STE 7, DIBERVILLE, MS 39540
(228) 365-0449
(228) 365-2314
Mailing address
11505 CINEMA DR STE 7, DIBERVILLE, MS 39540-9703
(228) 365-0449
(228) 365-2314
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1221
MS
363L00000X
Nurse Practitioner
901566
MS
Other
Enumeration date
12/26/2017
Last updated
07/10/2018
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