Healthcare Provider Details

I. General information

NPI: 1376576280
Provider Name (Legal Business Name): DEWEY REX CHALK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CLARK ST
GROVE HILL AL
36451
US

IV. Provider business mailing address

118 CLARK ST. P.O. BOX 579
GROVE HILL AL
36451
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-8460
  • Fax:
Mailing address:
  • Phone: 251-275-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0899
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: