Basic Information
| Provider Information | |||||||||
| NPI: | 1467651240 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | W.R. WEBB, CHIROPRACTOR | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 134 MARION AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396483620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842683 | ||||||||
| FaxNumber: | 6016846759 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 MARION AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396483620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842683 | ||||||||
| FaxNumber: | 6016846759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 08/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | WEBB | ||||||||
| AuthorizedOfficialFirstName: | WILLIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6016842683 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 350000243 | 01 | MS | C02487 | OTHER |