Provider Demographics
NPI:1033258686
Name:SOUTHEASTERN DIAGNOSTIC & REHABILITATION, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN DIAGNOSTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-682-1227
Mailing Address - Street 1:2321 JOHN HAWKINS PKWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3540
Mailing Address - Country:US
Mailing Address - Phone:205-682-1227
Mailing Address - Fax:205-682-1230
Practice Address - Street 1:2321 JOHN HAWKINS PKWY
Practice Address - Street 2:SUITE 113
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3540
Practice Address - Country:US
Practice Address - Phone:205-682-1227
Practice Address - Fax:205-682-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty