Back Room

NPI #1386905412 in Gulfport, Mississippi

Provider Information

NPI Number: 1386905412
Entity Type: Organization
Organization Name: Back Room
Primary Specialty: Chiropractor
Enumeration Date: Jun 5, 2012
Last Updated: Jun 13, 2012

Practice Location

Address: 15312 DEDEAUX RD
Address 2: SUITE A
City: Gulfport
State: Mississippi
ZIP Code: 39503-3123
Phone: (228) 331-2035

Authorized Official

Name: KATANYA FORD, D.C.
Title: CHIROPRACTOR
Phone: (228) 331-2035

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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