Provider Demographics
NPI:1497011811
Name:HEALTHSOURCE CHIROPRACTIC OF HAMPTON COVE, LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE CHIROPRACTIC OF HAMPTON COVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-536-8400
Mailing Address - Street 1:6388B HIGHWAY 431 S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9205
Mailing Address - Country:US
Mailing Address - Phone:256-536-8400
Mailing Address - Fax:256-536-8775
Practice Address - Street 1:6388B HIGHWAY 431 S
Practice Address - Street 2:SUITE 3
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9205
Practice Address - Country:US
Practice Address - Phone:256-536-8400
Practice Address - Fax:256-536-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1236111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty