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General NPI Number Information
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NPI Number | 1649407446
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Entity Type | Organization
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Legal Business Name | CENTRAL ALABAMA SPINE CENTER
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 52 MEDICAL PARK DR E SUITE 219
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3430
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Country | US
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Telephone | 205-655-2277
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Fax | 205-655-6037
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Provider Business Mailing Address
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Address Line | PO BOX 1198
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City | TRUSSVILLE
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State | AL
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Zip | 35173-6100
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Country | US
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Telephone | 205-655-2277
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Fax | 205-655-6037
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DESHAN SHERARD GROSS
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Credential | DC
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Telephone | 205-655-2277
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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 | 1151
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2065
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License Number State | AL
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