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General NPI Number Information
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NPI Number | 1023383163
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Entity Type | Organization
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Legal Business Name | PETRY CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 700 AL HIGHWAY 75 N
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City | ALBERTVILLE
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State | AL
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Zip | 35951-4014
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Country | US
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Telephone | 256-891-3733
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Fax | 256-891-0602
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Provider Business Mailing Address
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Address Line | 700 AL HIGHWAY 75 N
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City | ALBERTVILLE
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State | AL
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Zip | 35951-4014
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Country | US
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Telephone | 256-891-3733
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Fax | 256-891-0602
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDDIE P PETRY
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Credential | DC
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Telephone | 256-891-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 1566
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License Number State | AL
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