Provider Demographics
NPI:1346403557
Name:SOUTHALL, JUSTIN F (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:F
Last Name:SOUTHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FLY CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 FLY CREEK AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3843
Practice Address - Country:US
Practice Address - Phone:225-274-5507
Practice Address - Fax:251-928-0862
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor