Provider Demographics
NPI:1467646638
Name:ATTALLA FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ATTALLA FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-538-5955
Mailing Address - Street 1:209 GILBERT FERRY RD SE
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-3329
Mailing Address - Country:US
Mailing Address - Phone:256-538-5955
Mailing Address - Fax:256-538-5995
Practice Address - Street 1:209 GILBERT FERRY RD SE
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-3329
Practice Address - Country:US
Practice Address - Phone:256-538-5955
Practice Address - Fax:256-538-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917250Medicaid