Provider Demographics
NPI:1508999392
Name:SOUTHEASTERN CHIROPRACTIC ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:SOUTHEASTERN CHIROPRACTIC ASSOCIATES,P.C.
Other - Org Name:SOUTHEASTERN CHIROPRACTIC ASSOCIATES, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-673-1488
Mailing Address - Street 1:PO BOX 6853
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-6853
Mailing Address - Country:US
Mailing Address - Phone:334-673-1488
Mailing Address - Fax:334-673-8798
Practice Address - Street 1:1491 HARTFORD HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3349
Practice Address - Country:US
Practice Address - Phone:334-673-1488
Practice Address - Fax:334-673-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1497724645OtherNPI
AL350045914OtherRAILROAD MEDICARE PALMETT
AL51078506OtherBLUE CROSS BLUE SHIELD