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General NPI Number Information
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NPI Number | 1891231114
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 2112 6TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601-6510
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Country | US
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Telephone | 256-351-8500
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Fax | 256-351-0031
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Provider Business Mailing Address
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Address Line | 1600 BELTLINE ROAD
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City | DECATUR
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State | AL
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Zip | 35601
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Country | US
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Telephone | 256-351-8500
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Fax | 256-351-0031
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN MANN
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Credential |
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Telephone | 256-351-8500
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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 | 2438
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License Number State | AL
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