Provider Demographics
NPI:1568558575
Name:ROCKET CITY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ROCKET CITY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-721-9696
Mailing Address - Street 1:2417 JORDAN LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1009
Mailing Address - Country:US
Mailing Address - Phone:256-721-9696
Mailing Address - Fax:256-837-1206
Practice Address - Street 1:2417 JORDAN LANE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1009
Practice Address - Country:US
Practice Address - Phone:256-721-9696
Practice Address - Fax:256-837-1206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKET CITY CHIROPRACTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1832111N00000X
AL2225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51545643OtherBLUE CROSS BLUE SHIELDS
ALU68710Medicare UPIN