Provider Demographics
NPI:1386816023
Name:CHIROPRACTIC ASSOCIATE PC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-947-4111
Mailing Address - Street 1:22645 STATE HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-3393
Mailing Address - Country:US
Mailing Address - Phone:251-947-4111
Mailing Address - Fax:
Practice Address - Street 1:22645 STATE HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-3393
Practice Address - Country:US
Practice Address - Phone:251-947-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68376Medicare UPIN
AL5357890001Medicare NSC