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General NPI Number Information
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NPI Number | 1982810180
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Entity Type | Organization
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Legal Business Name | ELK RIVER CHIROPRACTIC CLINIC, P.A., P.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 17493 HIGHWAY 72
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City | ROGERSVILLE
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State | AL
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Zip | 35652-8109
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Country | US
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Telephone | 256-247-7702
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Fax | 256-247-7749
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Provider Business Mailing Address
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Address Line | 17493 HIGHWAY 72
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City | ROGERSVILLE
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State | AL
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Zip | 35652-8109
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Country | US
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Telephone | 256-247-7702
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Fax | 256-247-7749
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Authorized Official
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Title or Position | DR.
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Name | DR. LARRY THOMAS MARTIN
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Credential | D.C.
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Telephone | 256-247-7702
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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 | 1819
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License Number State | AL
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