Provider Demographics
NPI:1144377151
Name:DELILA ENTERPRISES DBA CHIROPRACTIC FIRST
Entity Type:Organization
Organization Name:DELILA ENTERPRISES DBA CHIROPRACTIC FIRST
Other - Org Name:CHIROPRACTIC FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:256-844-8215
Mailing Address - Street 1:1104 GAULT AVE S # A
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-4920
Mailing Address - Country:US
Mailing Address - Phone:256-844-8215
Mailing Address - Fax:256-844-8210
Practice Address - Street 1:1104 GAULT AVE S # A
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-4920
Practice Address - Country:US
Practice Address - Phone:256-844-8215
Practice Address - Fax:256-844-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503338BOUOtherBLUE CROSS
AL1497848428OtherPERSONAL NPI
ALU84425Medicare UPIN