Organization
BOONEVILLE CHIROPRACTIC CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK ROY BLYTHE D.C. (PRESIDENT)
(662) 728-7414
Entity
Organization
Contact information
Practice address
105B N 2ND ST, BOONEVILLE, MS 38829-3207
(662) 728-7414
(662) 728-4163
Mailing address
105B N 2ND ST, BOONEVILLE, MS 38829-3207
(662) 728-7414
(662) 728-4163
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
885
MS
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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