Provider Demographics
NPI:1164946281
Name:EERNISSE, DEVIN (DC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:EERNISSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2825
Mailing Address - Country:US
Mailing Address - Phone:256-233-7776
Mailing Address - Fax:256-233-7688
Practice Address - Street 1:1207 E FORREST ST STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2058
Practice Address - Country:US
Practice Address - Phone:256-233-7776
Practice Address - Fax:562-251-6229
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor