Provider Demographics
NPI:1376576280
Name:CHALK, DEWEY REX (DC)
Entity Type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:REX
Last Name:CHALK
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 1:118 CLARK ST.
Mailing Address - Street 2:P.O. BOX 579
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451
Mailing Address - Country:US
Mailing Address - Phone:251-275-8460
Mailing Address - Fax:
Practice Address - Street 1:118 CLARK ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451
Practice Address - Country:US
Practice Address - Phone:251-275-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL70384OtherBLUE CROSS-BLUE SHIELD
ALT68362Medicare UPIN
AL70384Medicare ID - Type Unspecified