Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1237 | MS |
NPI | 1003211723 |
---|---|
Provider Name | John Michael Varnado |
First Address | Picayune, MS 39466-5545 |
Second Address | Picayune, MS 39466-5545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 23/10/2014 |