Organization
WEST CHIROPRACTIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE C WEST DC (MANAGER)
(601) 434-2887
Entity
Organization
Contact information
Practice address
4700 HARDY ST STE M, HATTIESBURG, MS 39402-1300
(601) 261-5599
(601) 261-3295
Mailing address
4700 HARDY ST STE M, HATTIESBURG, MS 39402-1300
(601) 261-5599
(601) 261-3295
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114920
—
MS
01
—
1215021829
INDIVIDUAL NPI
—
01
—
587113627A
BLUE CROSS / BLUE SHIELD
MS
01
—
U31066
UPIN
—
Enumeration date
11/15/2022
Last updated
11/15/2022
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