Healthcare Provider Details

I. General information

NPI: 1821419318
Provider Name (Legal Business Name): PROTZ CHIROPRACTIC WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12815 US HIGHWAY 431
SARDIS CITY AL
35956-2046
US

IV. Provider business mailing address

12815 US HIGHWAY 431
SARDIS CITY AL
35956-2046
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-3551
  • Fax: 256-593-4603
Mailing address:
  • Phone: 256-593-3551
  • Fax: 256-593-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1632
License Number StateAL

VIII. Authorized Official

Name: DR. PAUL ANDREW PROTZ JR.
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 256-593-3551