Basic Information
| Provider Information | |||||||||
| NPI: | 1578660627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.C. | ||||||||
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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: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 523 | MS | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 0005235223 | 01 | MS | AETNA | OTHER | 00115214 | 05 | MS | MEDICAID | 4430039 | 01 | MS | UNITED HEALTHCARE | OTHER |