Provider Demographics
NPI:1750807301
Name:MID SOUTH CHIROPRACTIC OF HERNANDO PLLC
Entity type:Organization
Organization Name:MID SOUTH CHIROPRACTIC OF HERNANDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KASPRACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-890-0012
Mailing Address - Street 1:210 E COMMERCE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2308
Mailing Address - Country:US
Mailing Address - Phone:662-912-9294
Mailing Address - Fax:662-890-0522
Practice Address - Street 1:210 E COMMERCE ST STE 1
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2308
Practice Address - Country:US
Practice Address - Phone:662-890-0012
Practice Address - Fax:662-890-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528448685OtherINDIVIDUAL NPI