Organization
PEAVY CHIROPRACTIC CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN C PEAVY (SEC-TRES)
(601) 268-9093
Entity
Organization
Contact information
Practice address
2409 MAMIE ST, HATTIESBURG, MS 39401-7345
(601) 582-3343
(601) 583-6655
Mailing address
2409 MAMIE ST, HATTIESBURG, MS 39401-7345
(601) 582-3343
(601) 583-6655
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
353484066
BLUE CROSS & BLUE SHIELD
MS
01
—
C00559
MEDICARE GROUP #
MS
Enumeration date
02/02/2007
Last updated
10/26/2010
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