Healthcare Provider Details

I. General information

NPI: 1699764035
Provider Name (Legal Business Name): CLEBURNE CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 ROSS ST
HEFLIN AL
36264-1165
US

IV. Provider business mailing address

959 ROSS ST PO BOX 215
HEFLIN AL
36264-1165
US

V. Phone/Fax

Practice location:
  • Phone: 256-463-5555
  • Fax: 256-463-5537
Mailing address:
  • Phone: 256-463-5555
  • Fax: 256-463-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1330
License Number StateAL

VIII. Authorized Official

Name: DR. MARK J HAMMOCK
Title or Position: PRESIDENT CHIROPRACTOR
Credential: DC
Phone: 256-463-5555