MEDICARE: MOFFETT ROAD CHIROPRACTIC, P.C.

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	1844	AL
2	111N00000X	Chiropractor	1846	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51077800	OTHER	AL	BCBS
2	51077801	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1609973619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOFFETT ROAD CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	5017 MOFFETT RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36618-2207
Country	:	US
Telephone Number	:	251-380-0308
Fax Number	:	251-380-0309

Provider Business Practice Location Address
First Line	:	5017 MOFFETT RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36618-2207
Country	:	US
Telephone Number	:	251-380-0308
Fax Number	:	251-380-0309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESSICA SEEMATTER JONES
Credential	:	D.C.
Telephone Number	:	251-380-0308

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/09/2008

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Directions to “MOFFETT ROAD CHIROPRACTIC, P.C. ” Practice Location

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