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General NPI Number Information
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NPI Number | 1144490129
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Entity Type | Organization
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Legal Business Name | BAYSIDE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 30941 MILL LANE UNIT B
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City | DAPHNE
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State | AL
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Zip | 36526
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Country | US
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Telephone | 251-626-8242
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Fax |
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Provider Business Mailing Address
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Address Line | 30941 MILL LANE UNIT B
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City | DAPHNE
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State | AL
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Zip | 36526
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Country | US
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Telephone | 251-626-8242
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. LESLIE MICHELLE BRYAN
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Credential | D.C.
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Telephone | 251-626-8242
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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 | 2388
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License Number State | AL
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