Provider Demographics
NPI:1558682153
Name:ALI BACK & BODY INC
Entity Type:Organization
Organization Name:ALI BACK & BODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKEEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-927-2095
Mailing Address - Street 1:2310 SW MILITARY DR
Mailing Address - Street 2:NO. 404
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1407
Mailing Address - Country:US
Mailing Address - Phone:210-927-2095
Mailing Address - Fax:210-927-2096
Practice Address - Street 1:2310 SW MILITARY DR
Practice Address - Street 2:NO. 404
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1407
Practice Address - Country:US
Practice Address - Phone:210-927-2095
Practice Address - Fax:210-927-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558682153Medicaid
TX1558682153Medicaid