Provider Demographics
NPI:1104017433
Name:ISLAND FAMILY CHIROPRACTIC , P.C.
Entity Type:Organization
Organization Name:ISLAND FAMILY CHIROPRACTIC , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-981-8979
Mailing Address - Street 1:24693 CANAL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-3813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24693 CANAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3813
Practice Address - Country:US
Practice Address - Phone:251-981-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL201568Medicare UPIN