Organization
GAUTIER CHIROPRACTIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GROVER DALE JOHNSON D.C. (DIRECTOR)
(228) 202-5106
Entity
Organization
Contact information
Practice address
3105 SHAW DRIVE, GAUTIER, MS 39553-5507
(228) 202-5106
(228) 202-5107
Mailing address
3105 SHAW DRIVE, GAUTIER, MS 39553-5507
(228) 202-5106
(228) 202-5107
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
415
MS
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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