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General NPI Number Information
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NPI Number | 1366794703
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Entity Type | Organization
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Legal Business Name | BACK TO FITNESS
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 1580 LORLEEN WALLACE BLVD.
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City | NORTHPORT
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State | AL
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Zip | 35476
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Country | US
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Telephone | 205-345-2225
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Fax | 205-345-2217
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Provider Business Mailing Address
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Address Line | 1580 LORLEEN WALLACE BLVD.
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City | NORTHPORT
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State | AL
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Zip | 35476
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Country | US
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Telephone | 205-345-2225
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Fax | 205-345-2217
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Authorized Official
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Title or Position | AGENT
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Name | DR. KERRY THOMAS HILL
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Credential | D.C.
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Telephone | 205-345-2225
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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 | 1930
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License Number State | AL
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