Provider Demographics
NPI:1356841183
Name:PROACTIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:PROACTIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-848-7333
Mailing Address - Street 1:2025 OLD MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1606
Mailing Address - Country:US
Mailing Address - Phone:205-848-7333
Mailing Address - Fax:205-848-8686
Practice Address - Street 1:2025 OLD MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1606
Practice Address - Country:US
Practice Address - Phone:205-848-7333
Practice Address - Fax:205-848-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty