BACK CARE CENTER, INC. (NPI# 1922254929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922254929 |
| Entity Type | Organization |
| Organization Name | BACK CARE CENTER, INC. |
| Other Organization Name | RESERVOIR CHIROPRACTIC-BACK CARE CENTER, INC. |
| Practice Address |
1149 Old Fannin Rd Suite 22 Brandon MS 39047-9244 |
| Practice Telephone | 6019923050 |
| Practice Fax Number | 6019923051 |
| Mailing Telephone | 6019923050 |
| Mailing Fax Number | 6019923051 |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2008-09-15 |
| Authorized Official Name | DR. CHARLES V MATHEWS (CHIROPRACTOR) |
| Authorized Official Telephone | 6019923050 |
| Authorized Official Credential | M.S., D. C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 0230 | MS | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | MEDICARE IDENTIFICATION NUMBER | 350000104 | 01 |
| Other Name | Type Code |
|---|---|
| Reservoir Chiropractic-Back Care Center, Inc. | Doing Business As Name - Organization |
| Street Address |
1149 OLD FANNIN RD SUITE 22 |
| City | BRANDON |
| State | MS |
| Zip Code | 39047-9244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801930532 | Susanne Reynolds Moore | Dentist | 1149 Old Fannin Rd, Suite 26, Brandon, MS 39047 | 2007-02-16 |
| 1376089904 | Hazel Mccaughan | Dentist | 1149 Old Fannin Rd, #26, Brandon, MS 39047-9244 | 2017-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368783 | Siyuan Chen Kennedy | Counselor | 108 Sandstone Drive, Brandon, MS 39047 | 2020-05-20 |
| 1568019784 | Juarez Brown Emerson | Registered Nurse | 426 Pinebrook Circle, Brandon, MS 39047 | 2019-08-22 |
| 1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
| 1528423035 | Kathlene Strangeman | Social Worker | 111 Lakeshore Dr Apt G403, Brandon, MS 39047 | 2015-12-28 |
| 1174935076 | Anthony Davis | Counselor | 198 Bellegrove Cir, Brandon, MS 39047 | 2014-05-27 |
| 1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
| 1437429941 | Picton Timothy Evans | Pharmacist | 150 B Cumberland Ed, Brandon, MS 39047 | 2012-01-01 |
| 1275828030 | Kathryn Audell Piburn | Nurse Practitioner | 1887 Spillway Rd Ste 140, Brandon, MS 39047 | 2011-06-09 |
| 1194898429 | Brookshire Grocery Company | Durable Medical Equipment & Medical Supplies | 143 Plaza Drive Ext, Attention Pharmacy Dept, Brandon, MS 39047 | 2006-11-16 |
| 1972530632 | Claudia Weir Anthony | Nurse Practitioner | 1887 Spillway Rd, Brandon, MS 39047 | 2006-06-27 |
| Find all providers in zip 39047 | ||||
| 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 |
|---|---|---|---|---|
| 1013419563 | Brandon Family Chiropractic LLC | Chiropractor | 1350 West Government Street Suite A1, Brandon, MS 39042 | 2018-03-01 |
| 1932569704 | Haley Wilson | Chiropractor | 1350 W Government St Ste A1, Brandon, MS 39042 | 2016-03-07 |
| 1538541552 | New Day Chiropractic and Health Solutions,llc | Chiropractor | 125 Hollybush Pl, Brandon, MS 39047-7332 | 2015-06-25 |
| 1790175388 | Cody Lee Kruckenberg | Chiropractor | 312 E Holly Blvd, Brandon, SD 57005 | 2015-02-03 |
| 1881943900 | Kennedy Chiropractic Clinic Inc | Chiropractor | 393 Crossgates Blvd, Suite B, Brandon, MS 39042 | 2012-09-05 |
| 1366719619 | Ronald Jack Travis Utter | Chiropractor | 1355 Oakfield Dr, Brandon, FL 33511-4841 | 2011-11-30 |
| 1669776985 | Amanda Michelle Lenth | Chiropractor | 1806 Sterling Palms Ct Apt 302, Brandon, FL 33511-1728 | 2010-12-29 |
| 1073844684 | Vanessa Nichola Benton | Chiropractor | 500 Vonderburg Dr Ste 105, Brandon, FL 33511-5968 | 2010-01-21 |
| 1477788917 | Chad Franklin Polley | Chiropractor | 166 E Bloomingdale Ave, Suite B, Brandon, FL 33511-8101 | 2009-05-28 |
| 1104079466 | Richard E. Rogovin, Dc, Pa | Chiropractor | 506 Westbrook Ave, Brandon, FL 33511-5316 | 2008-10-30 |
| Find all providers in BRANDON | ||||
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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.