Individual
MR. VANCE RAY WARDEN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
19621 HWY 63, MOSS POINT, MS 39562
(228) 588-0188
(228) 588-9184
Mailing address
PO BOX 901, HURLEY, MS 39555-0901
(228) 588-0188
(228) 588-9184
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0987
MS
363LF0000X
Family Nurse Practitioner
F0113056
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123522
—
MS
01
—
350000283
PTAN
MS
Enumeration date
03/09/2007
Last updated
03/11/2022
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