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General NPI Number Information
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NPI Number | 1558551770
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 190 ANA DRIVE
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City | FLORENCE
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State | AL
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Zip | 35630
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Country | US
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Telephone | 256-767-1890
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Fax | 256-764-8249
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Provider Business Mailing Address
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Address Line | 190 ANA DRIVE
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City | FLORENCE
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State | AL
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Zip | 35630
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Country | US
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Telephone | 256-767-1890
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Fax | 256-764-8249
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ANDREW MARINO
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Credential | DC
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Telephone | 256-767-1890
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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 | 1721
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License Number State | AL
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