Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1014 | MS |
NPI | 1003977646 |
---|---|
Provider Name | Dr. Matt Mackey |
First Address | Tupelo, MS 38804-7500 |
Second Address | Tupelo, MS 38804-7500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |