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General NPI Number Information
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NPI Number | 1700151255
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Entity Type | Organization
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Legal Business Name | MISSION SQUARE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 49 MITCHELL DR
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City | MONTGOMERY
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State | AL
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Zip | 36109-2923
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Country | US
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Telephone | 800-764-0911
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Fax | 800-764-8611
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Provider Business Mailing Address
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Address Line | PO BOX 20572
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City | MONTGOMERY
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State | AL
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Zip | 36120-0572
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Country | US
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Telephone | 800-764-0911
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Fax | 800-764-8611
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALAN JEROME TRENT SR.
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Credential |
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Telephone | 334-676-0166
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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 |
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License Number State |
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