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Organization

MATTHEWS CHIROPRACTIC CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ENDRE DEJUAN MATTHEWS (OWNER)
(601) 366-9005
Entity
Organization

Contact information

Practice address
4515 OFFICE PARK DRIVE, JACKSON, MS 39206
(601) 366-9005
Mailing address
4515 OFFICE PARK DR, JACKSON, MS 39206-6017
(601) 366-9005

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1015
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00125438
MS
Enumeration date
07/21/2009
Last updated
07/21/2009
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