Provider Demographics
NPI:1396830360
Name:GREMMELS CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:GREMMELS CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:GREMMELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-854-3008
Mailing Address - Street 1:1705 CENTER POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5505
Mailing Address - Country:US
Mailing Address - Phone:205-854-3008
Mailing Address - Fax:205-854-0242
Practice Address - Street 1:1705 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5505
Practice Address - Country:US
Practice Address - Phone:205-854-3008
Practice Address - Fax:205-854-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2152111N00000X
AL989111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68424Medicare UPIN