Provider Demographics
NPI:1003229741
Name:TILLMANS CORNER CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:TILLMANS CORNER CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-661-0322
Mailing Address - Street 1:5369 HIGHWAY 90 W STE C
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-4223
Mailing Address - Country:US
Mailing Address - Phone:251-661-0322
Mailing Address - Fax:
Practice Address - Street 1:5369 HIGHWAY 90 W STE C
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-4223
Practice Address - Country:US
Practice Address - Phone:251-661-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty