MEDICARE: MONTGOMERY NECK AND BACK PAIN CENTER

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	1611	AL

General Provider Information

NPI Number	:	1699034090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY NECK AND BACK PAIN CENTER

Provider Business Mailing Address
First Line	:	4171 LOMAC ST
Second Line	:	SUITE A
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2945
Country	:	US
Telephone Number	:	334-272-3030
Fax Number	:	334-272-9912

Provider Business Practice Location Address
First Line	:	4171 LOMAC ST
Second Line	:	SUITE A
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2945
Country	:	US
Telephone Number	:	334-272-3030
Fax Number	:	334-272-9912

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH DANIEL HOGAN III
Credential	:	DC
Telephone Number	:	334-272-3030

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	07/10/2012

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