Provider Demographics
NPI:1447980198
Name:OLDE TOWNE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:OLDE TOWNE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-460-1146
Mailing Address - Street 1:420 MONROE ST STE C
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4226
Mailing Address - Country:US
Mailing Address - Phone:601-460-1146
Mailing Address - Fax:
Practice Address - Street 1:420 MONROE ST STE C
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4226
Practice Address - Country:US
Practice Address - Phone:601-460-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty