Individual
DR. JOHN MACKERTICH BAMBAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
11516 LAMEY BRIDGE RD STE E, DIBERVILLE, MS 39540-2725
(228) 207-6427
(228) 207-6428
Mailing address
10028B FOURNIER AVE, DIBERVILLE, MS 39540-5424
(770) 733-5205
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1179
MS
111NN1001X
Nutrition Chiropractor
1179
MS
111NR0400X
Rehabilitation Chiropractor
1179
MS
111NS0005X
Sports Physician Chiropractor
1179
MS
Other
Enumeration date
08/12/2011
Last updated
10/19/2020
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