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General NPI Number Information
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NPI Number | 1265701122
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF HARVEST
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 5850 HIGHWAY 53 STE. N
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City | HARVEST
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State | AL
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Zip | 35749-4301
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Country | US
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Telephone | 256-852-2000
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Fax | 256-852-2232
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Provider Business Mailing Address
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Address Line | 5850 HWY 53 SUITE N
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City | HARVEST
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State | AL
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Zip | 35749-4302
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Country | US
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Telephone | 256-852-2000
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Fax | 256-852-2232
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Authorized Official
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Title or Position | PARTNER/CHIROPRACTOR
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Name | MRS. AMY CATHERINE LAWRENCE
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Credential | D.C.
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Telephone | 256-852-2000
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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 | #2111
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License Number State | AL
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