# BOONEVILLE CHIROPRACTIC CLINIC, P.A.

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

## Provider details

- **NPI number:** 1154697910
- **Authorized official:** DR. DERRICK ROY BLYTHE D.C. (PRESIDENT)
- **Authorized official phone:** (662) 728-7414

## Contact information

- **Practice address:** 105B N 2ND ST, BOONEVILLE, MS 38829-3207
- **Practice address phone:** (662) 728-7414
- **Practice address fax:** (662) 728-4163
- **Mailing address:** 105B N 2ND ST, BOONEVILLE, MS 38829-3207
- **Mailing address phone:** (662) 728-7414
- **Mailing address fax:** (662) 728-4163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 885 | MS | Yes |

## Other

- **Enumeration date:** 03/27/2012
- **Last updated:** 03/27/2012