Provider Demographics
NPI:1578794418
Name:ANDALUSIA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ANDALUSIA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ANDALUSIA CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLANCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-222-2301
Mailing Address - Street 1:1805 E THREE NOTCH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36421-2403
Mailing Address - Country:US
Mailing Address - Phone:334-222-2301
Mailing Address - Fax:334-222-2305
Practice Address - Street 1:1805 E THREE NOTCH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36421-2403
Practice Address - Country:US
Practice Address - Phone:334-222-2301
Practice Address - Fax:334-222-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty