Basic Information
| Provider Information | |||||||||
| NPI: | 1770530248 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOXWORTH CHIROPRACTIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2470 FLOWOOD DR | ||||||||
| Address2: | STE 125 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019329201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2470 FLOWOOD DRIVE | ||||||||
| Address2: | STE 125 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019329201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | CEFALU | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6019329201 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 09882002 | 05 | MS | MEDICAID |