Provider Demographics
NPI:1083070460
Name:GARGUS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GARGUS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GARGUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:706-831-0673
Mailing Address - Street 1:6521 HIGHWAY 69 S
Mailing Address - Street 2:SUITE N
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3964
Mailing Address - Country:US
Mailing Address - Phone:205-345-5035
Mailing Address - Fax:205-345-5034
Practice Address - Street 1:6521 HIGHWAY 69 S
Practice Address - Street 2:SUITE N
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3964
Practice Address - Country:US
Practice Address - Phone:205-345-5035
Practice Address - Fax:205-345-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty