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General NPI Number Information
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NPI Number | 1144501495
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Entity Type | Organization
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Legal Business Name | CHIRO WELLNESS CENTER LLC
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 1951 HOOVER CT SUITE 101
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City | HOOVER
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State | AL
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Zip | 35226-3606
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Country | US
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Telephone | 205-979-5692
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Fax | 205-979-3697
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Provider Business Mailing Address
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Address Line | 1951 HOOVER CT SUITE 101
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City | HOOVER
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State | AL
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Zip | 35226-3606
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Country | US
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Telephone | 205-979-5692
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Fax | 205-979-3697
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JOHN KENNEDY
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Credential | DC
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Telephone | 205-979-5692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1795
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License Number State | AL
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