Provider Demographics
NPI:1164582557
Name:SHIVER CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:SHIVER CHIROPRACTIC CLINIC, P.C.
Other - Org Name:HANNEN HEALTH CARE CLINIC, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-393-9355
Mailing Address - Street 1:PO BOX 311427
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1427
Mailing Address - Country:US
Mailing Address - Phone:334-393-9355
Mailing Address - Fax:334-393-4372
Practice Address - Street 1:809 E LEE ST STE A
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2072
Practice Address - Country:US
Practice Address - Phone:334-393-3955
Practice Address - Fax:334-393-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-54001OtherBLUE CROSS BLUE SHIELD
AL515-54001OtherBLUE CROSS BLUE SHIELD
AL051554001Medicare PIN