MEDICARE: DR DOCTOR DISC INJURY AND SPINAL CARE CLINIC PC

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	261QM2500X	Medical Specialty Clinic/Center	2346	AL

General Provider Information

NPI Number	:	1346660487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DOCTOR DISC INJURY AND SPINAL CARE CLINIC PC

Provider Business Mailing Address
First Line	:	1117 7TH AVE W
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-3408
Country	:	US
Telephone Number	:	844-223-3737
Fax Number	:	844-373-7329

Provider Business Practice Location Address
First Line	:	1117 7TH AVE W
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-3408
Country	:	US
Telephone Number	:	844-223-3737
Fax Number	:	844-373-7329

Authorized Official
Title or Position	:	CEO AND FOUNDER
Name	:	DR. ZEBOYE ARCHELL DOCTOR
Credential	:	DC
Telephone Number	:	904-250-3737

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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