Healthcare Provider Details

I. General information

NPI: 1952623316
Provider Name (Legal Business Name): ALABAMA FAMILY CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 W 3RD ST
MONTGOMERY AL
36106-1506
US

IV. Provider business mailing address

1714 W 3RD ST
MONTGOMERY AL
36106-1506
US

V. Phone/Fax

Practice location:
  • Phone: 334-834-6282
  • Fax: 334-834-6418
Mailing address:
  • Phone: 334-834-6282
  • Fax: 334-834-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1762
License Number StateAL

VIII. Authorized Official

Name: MRS. SUSAN HENRY
Title or Position: BILLING PROFESSIONAL
Credential:
Phone: 334-396-6988