Provider Demographics
NPI:1871882407
Name:POE, FELICIA FAYE (DC)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:FAYE
Last Name:POE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SUNSET LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4508
Mailing Address - Country:US
Mailing Address - Phone:662-226-8071
Mailing Address - Fax:662-226-8072
Practice Address - Street 1:30 SUNSET LOOP STE A
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4508
Practice Address - Country:US
Practice Address - Phone:662-226-8071
Practice Address - Fax:662-226-8072
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1174OtherLICENSE NUMBER