Provider Demographics
NPI:1073846309
Name:SELMA PAIN & INJURY CENTER
Entity Type:Organization
Organization Name:SELMA PAIN & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-951-3330
Mailing Address - Street 1:800 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4926
Mailing Address - Country:US
Mailing Address - Phone:334-872-0800
Mailing Address - Fax:
Practice Address - Street 1:800 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4926
Practice Address - Country:US
Practice Address - Phone:334-872-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51074897OtherBLUE CROSS OF ALABAMA
AL51074897OtherBLUE CROSS OF ALABAMA