Provider Demographics
NPI:1609973619
Name:MOFFETT ROAD CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MOFFETT ROAD CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SEEMATTER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-380-0308
Mailing Address - Street 1:5017 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2207
Mailing Address - Country:US
Mailing Address - Phone:251-380-0308
Mailing Address - Fax:251-380-0309
Practice Address - Street 1:5017 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2207
Practice Address - Country:US
Practice Address - Phone:251-380-0308
Practice Address - Fax:251-380-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1844111N00000X
AL1846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51077800OtherBCBS
AL51077801OtherBCBS