Healthcare Provider Details

I. General information

NPI: 1780706804
Provider Name (Legal Business Name): RAINSVILLE CHIROPRACTIC MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN STREET WEST
RAINSVILLE AL
35986-0423
US

IV. Provider business mailing address

PO BOX 423 460 MAIN STREET W
RAINSVILLE AL
35986-0423
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-4228
  • Fax: 256-638-6099
Mailing address:
  • Phone: 256-638-4228
  • Fax: 256-638-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0732
License Number StateAL

VIII. Authorized Official

Name: ROGER L INGRAM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 256-638-4228