Healthcare Provider Details

I. General information

NPI: 1588084214
Provider Name (Legal Business Name): CENTRAL ALABAMA CLINIC OF CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 CHANDALAR DR STE D
PELHAM AL
35124-1393
US

IV. Provider business mailing address

5803 SWEETBRIER LN
TUSCALOOSA AL
35405-5658
US

V. Phone/Fax

Practice location:
  • Phone: 205-358-3515
  • Fax: 205-358-3517
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2391
License Number StateAL

VIII. Authorized Official

Name: DR. PERRY HARRISON
Title or Position: OWNER
Credential: D.C.
Phone: 205-535-0990