Provider Demographics
NPI:1043377054
Name:CHIROPRACTIC CLINIC P. A.
Entity Type:Organization
Organization Name:CHIROPRACTIC CLINIC P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-234-2671
Mailing Address - Street 1:440 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-2582
Mailing Address - Country:US
Mailing Address - Phone:256-234-2671
Mailing Address - Fax:
Practice Address - Street 1:440 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-2582
Practice Address - Country:US
Practice Address - Phone:256-234-2671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070446OtherBCBS OF AL