=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659856359
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEST FOR HEALTH CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2018
-----------------------------------------------------
Last Update Date | 09/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 N CHALKVILLE RD STE 112
-----------------------------------------------------
City | TRUSSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35173-1063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-259-6476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 N CHALKVILLE RD STE 112
-----------------------------------------------------
City | TRUSSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35173-1063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-259-6476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PART OWNER
-----------------------------------------------------
Name | DR. KEITH HALLINGQUEST
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 205-259-6476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------