Provider Demographics
NPI:1356495378
Name:WEST MOBILE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:WEST MOBILE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-344-8588
Mailing Address - Street 1:260 CODY RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3408
Mailing Address - Country:US
Mailing Address - Phone:251-344-8588
Mailing Address - Fax:251-344-8985
Practice Address - Street 1:260 CODY RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3408
Practice Address - Country:US
Practice Address - Phone:251-344-8588
Practice Address - Fax:251-344-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4410063OtherUNITED HEALTH CARE
AL14767OtherPRINCIPAL HEALTH
AL4664879OtherAETNA
AL51070922OtherBLUE CROSS BLUE SHIELD
ALT68625OtherVIVA
AL770616OtherFIRST HEALTH
AL388534OtherCCN
ALT68625OtherVIVA
AL14767OtherPRINCIPAL HEALTH