Provider Demographics
NPI:1770766495
Name:RATHBURN CHIROPRACTICCLINIC
Entity type:Organization
Organization Name:RATHBURN CHIROPRACTICCLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RATHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-924-4647
Mailing Address - Street 1:612 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5123
Mailing Address - Country:US
Mailing Address - Phone:601-924-4647
Mailing Address - Fax:601-926-4799
Practice Address - Street 1:612 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5123
Practice Address - Country:US
Practice Address - Phone:601-924-4647
Practice Address - Fax:601-926-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS514646023BOtherBC/BS OF MS
MS350000326Medicare PIN
MS514646023BOtherBC/BS OF MS