Provider Demographics
NPI:1043409196
Name:PROHEALTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PROHEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-713-8130
Mailing Address - Street 1:2124 CECIL ASHBURN DR SE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2124 CECIL ASHBURN DR SE
Practice Address - Street 2:SUITE 150
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2574
Practice Address - Country:US
Practice Address - Phone:256-713-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51542919OtherBC/BS