Provider Demographics
NPI:1942964598
Name:GRESSETT, CALEB VAN (DC)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:VAN
Last Name:GRESSETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKELAND SQUARE EXT STE 400
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7621
Mailing Address - Country:US
Mailing Address - Phone:601-932-3855
Mailing Address - Fax:601-932-6557
Practice Address - Street 1:1000 LAKELAND SQUARE EXT STE 400
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7621
Practice Address - Country:US
Practice Address - Phone:601-932-3855
Practice Address - Fax:601-932-6557
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1346OtherMS BOARD OF CHIROPRACTIC EXAMINERS