Healthcare Provider Details

I. General information

NPI: 1740650621
Provider Name (Legal Business Name): TRUSSVILLE CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 OLD SPRINGVILLE RD
PINSON AL
35126-3183
US

IV. Provider business mailing address

PO BOX 283
CLAY AL
35048-0283
US

V. Phone/Fax

Practice location:
  • Phone: 205-520-0091
  • Fax:
Mailing address:
  • Phone: 256-962-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1953
License Number StateAL

VIII. Authorized Official

Name: STEPHEN EDWARDS
Title or Position: DIRECTOR
Credential: D.C.
Phone: 256-962-0136