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General NPI Number Information
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NPI Number | 1134396898
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 2412 US HWY 231
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City | WETUMPKA
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State | AL
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Zip | 36092
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Country | US
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Telephone | 334-514-7327
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Fax | 334-514-7328
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Provider Business Mailing Address
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Address Line | 1504 PRAIRIE LN
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City | MONTGOMERY
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State | AL
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Zip | 36117-3477
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Country | US
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Telephone | 334-318-1427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOBBY JOSEPH LUSTER
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Credential | D.C.
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Telephone | 334-514-7327
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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 | 2153
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License Number State | AL
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