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General NPI Number Information
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NPI Number | 1083070460
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Entity Type | Organization
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Legal Business Name | GARGUS CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 6521 HIGHWAY 69 S SUITE N
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City | TUSCALOOSA
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State | AL
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Zip | 35405-3964
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Country | US
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Telephone | 205-345-5035
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Fax | 205-345-5034
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Provider Business Mailing Address
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Address Line | 6521 HIGHWAY 69 S SUITE N
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City | TUSCALOOSA
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State | AL
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Zip | 35405-3964
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Country | US
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Telephone | 205-345-5035
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Fax | 205-345-5034
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY ALAN GARGUS JR.
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Credential | D.C.
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Telephone | 706-831-0673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2373
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License Number State | AL
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