BACK ROOM (NPI# 1386905412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386905412 |
| Entity Type | Organization |
| Organization Name | BACK ROOM |
| Practice Address |
15312 Dedeaux Rd Suite A Gulfport MS 39503-3123 |
| Practice Telephone | 2283312035 |
| Mailing Telephone | 2283312035 |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-13 |
| Authorized Official Name | KATANYA FORD (CHIROPRACTOR) |
| Authorized Official Telephone | 2283312035 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 1162 | MS | Chiropractic Providers |
| Street Address |
15312 DEDEAUX RD SUITE A |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-3123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225408628 | Perez Vision Clinic | Optometrist | 15312 Dedeaux Rd, Gulfport, MS 39503-3123 | 2015-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487297123 | Shelby Wittorf | Chiropractor | 370 Courthouse Rd Ste 101, Gulfport, MS 39507-1889 | 2019-10-25 |
| 1104312735 | Anthony William Lopez Jr. | Chiropractor | 15007 Creosote Rd Ste A, Gulfport, MS 39503-4392 | 2018-07-06 |
| 1578929329 | Marissa Lyn Hols | Chiropractor | 6320 7th Ave S, Gulfport, FL 33707-2305 | 2016-01-10 |
| 1083088488 | William Bankester | Chiropractor | 8950 Lorraine Rd Ste C, Gulfport, MS 39503-4183 | 2015-11-23 |
| 1063805083 | Dr. Elizabeth A. Douglas D.c. | Chiropractor | 4933 14th Ave S, Gulfport, FL 33707-3622 | 2015-03-16 |
| 1083042170 | Brandon Hardin | Chiropractor | 370 Courthouse Rd, 101, Gulfport, MS 39507-1889 | 2013-10-29 |
| 1285060954 | Lance Ellis Cleveland | Chiropractor | 45 Hardy Court Ctr, Ste. 103, Gulfport, MS 39507-2501 | 2013-09-25 |
| 1083999130 | Katanya D Ford | Chiropractor | 1243 28th St Ste A, Gulfport, MS 39501-6203 | 2011-10-19 |
| 1013151638 | Bradford Joseph Dewitt | Chiropractor | 15465 Oak Ln Ste 100b, Gulfport, MS 39503-2663 | 2009-04-27 |
| 1306009303 | Coast Nerve & Spine Center, LLC | Chiropractor | 15037 Dedeaux Rd, Gulfport, MS 39503-3284 | 2008-07-09 |
| Find all providers in GULFPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.