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General NPI Number Information
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NPI Number | 1851723274
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Entity Type | Organization
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Legal Business Name | MODERN CHIROPRACTIC
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 377 HUNTLEY PKWY
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City | PELHAM
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State | AL
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Zip | 35124-6164
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Country | US
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Telephone | 205-621-2221
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Fax | 205-663-9160
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Provider Business Mailing Address
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Address Line | 377 HUNTLEY PKWY
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City | PELHAM
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State | AL
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Zip | 35124-6164
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Country | US
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Telephone | 205-621-2221
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. KENNETH MICHAEL TALLEY
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Credential | D.C.
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Telephone | 205-621-2221
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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 | AL
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