Provider Demographics
NPI:1033248802
Name:ASSOCIATED CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ASSOCIATED CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-237-9423
Mailing Address - Street 1:217 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5725
Mailing Address - Country:US
Mailing Address - Phone:256-237-9423
Mailing Address - Fax:256-237-6007
Practice Address - Street 1:217 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5725
Practice Address - Country:US
Practice Address - Phone:256-237-9423
Practice Address - Fax:256-237-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-20259OtherBLUE CROSS PROVIDER
ALU83772Medicare UPIN
AL051554597Medicare ID - Type UnspecifiedMEDICARE