MEDICARE: CHIROPRACTIC CLINIC P. A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0935	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51070446	OTHER	AL	BCBS OF AL

General Provider Information

NPI Number	:	1043377054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CLINIC P. A.

Provider Business Mailing Address
First Line	:	440 CHURCH ST
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-2582
Country	:	US
Telephone Number	:	256-234-2671
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 CHURCH ST
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-2582
Country	:	US
Telephone Number	:	256-234-2671
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOE WARREN JORDAN
Credential	:	D.C.
Telephone Number	:	256-234-2671

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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