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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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