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Individual

MR. JAMES D VICTORY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
315 HIGHWAY 90, GAUTIER, MS 39553
(228) 497-9907
(228) 497-9917
Mailing address
P.O. BOX 760, GAUTIER, MS 39553
(228) 497-9907
(228) 497-9917

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
980
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00123096
MS
05
08755862
MS
01
1866765
FRIST HEALTH PROVIDER #
MS
01
64-0931880
TAX ID #
MS
01
645632
UNITED HEALTHCARE PROVIDE
MS
01
7614197
AETNA PROVIDER #
MS
Enumeration date
10/05/2006
Last updated
08/29/2018
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