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General NPI Number Information
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NPI Number | 1356466379
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Entity Type | Organization
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Legal Business Name | FORME MEDICAL &BURGESS CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 3001 MCCLELLAN BLVD
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City | ANNISTON
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State | AL
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Zip | 36201-2724
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Country | US
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Telephone | 256-237-9251
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Fax | 256-236-7397
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Provider Business Mailing Address
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Address Line | 3001 MCCLELLAN BLVD
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City | ANNISTON
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State | AL
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Zip | 36201-2724
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Country | US
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Telephone | 256-237-9251
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Fax | 256-236-7397
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. DALE C BURGESS
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Credential | DC
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Telephone | 256-237-9251
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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 | 915
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License Number State | AL
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