Provider Demographics
NPI:1902075963
Name:DR. DOROTHEY A. PERNELL, D. C., P. A.
Entity Type:Organization
Organization Name:DR. DOROTHEY A. PERNELL, D. C., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:662-455-2807
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-0444
Mailing Address - Country:US
Mailing Address - Phone:662-455-2807
Mailing Address - Fax:662-455-9994
Practice Address - Street 1:408 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4539
Practice Address - Country:US
Practice Address - Phone:662-455-2807
Practice Address - Fax:662-455-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS425159165AOtherBCBS
MS00115315Medicaid
MS00115315Medicaid