Provider Demographics
NPI:1114795291
Name:SUPERSPINE CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:SUPERSPINE CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:210-591-4165
Mailing Address - Street 1:2738 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1838
Mailing Address - Country:US
Mailing Address - Phone:205-879-2273
Mailing Address - Fax:
Practice Address - Street 1:2738 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-1838
Practice Address - Country:US
Practice Address - Phone:205-879-2273
Practice Address - Fax:205-443-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty