Provider Demographics
NPI:1346515798
Name:GLENCOE FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GLENCOE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-390-6490
Mailing Address - Street 1:528 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AL
Mailing Address - Zip Code:35905-1060
Mailing Address - Country:US
Mailing Address - Phone:256-390-6490
Mailing Address - Fax:
Practice Address - Street 1:528 MAIN ST W
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:AL
Practice Address - Zip Code:35905-1060
Practice Address - Country:US
Practice Address - Phone:256-390-6490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty