Provider Demographics
NPI:1093022600
Name:ALIGN CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:ALIGN CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:MYRACLE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-885-0461
Mailing Address - Street 1:1003 E REELFOOT AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5871
Mailing Address - Country:US
Mailing Address - Phone:731-885-0461
Mailing Address - Fax:
Practice Address - Street 1:1003 E REELFOOT AVE STE 4
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5871
Practice Address - Country:US
Practice Address - Phone:731-885-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I352408Medicare PIN
TN6522520001Medicare NSC