Provider Demographics
NPI:1235337320
Name:DR. WADE O'MARY, INC.
Entity Type:Organization
Organization Name:DR. WADE O'MARY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELESIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-384-5358
Mailing Address - Street 1:301 22ND AVE E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4023
Mailing Address - Country:US
Mailing Address - Phone:205-384-5358
Mailing Address - Fax:205-384-5360
Practice Address - Street 1:301 22ND AVE E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4023
Practice Address - Country:US
Practice Address - Phone:205-384-5358
Practice Address - Fax:205-384-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523516Medicare PIN
ALT68519Medicare UPIN