Healthcare Provider Details

I. General information

NPI: 1902995285
Provider Name (Legal Business Name): MILLBROOK FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 HIGHWAY 14
MILLBROOK AL
36054-2424
US

IV. Provider business mailing address

PO BOX 847
MILLBROOK AL
36054-0018
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-8483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2130
License Number StateAL

VIII. Authorized Official

Name: DR. JEFFREY DAVID PASLEY
Title or Position: MANAGER
Credential: D.C.
Phone: 334-285-8483