Provider Demographics
NPI:1477694636
Name:SOUTHERLAND, CARRIE GAIL (BS, DC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:GAIL
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12844 US HIGHWAY 431 STE B
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-9312
Mailing Address - Country:US
Mailing Address - Phone:256-582-4330
Mailing Address - Fax:256-582-4115
Practice Address - Street 1:12844 US HIGHWAY 431 STE B
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-9312
Practice Address - Country:US
Practice Address - Phone:256-582-4330
Practice Address - Fax:256-582-4115
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515065Medicare ID - Type Unspecified
ALV06571Medicare UPIN