Provider Demographics
NPI:1689647067
Name:COLEMAN, EFREM GLENN (DC)
Entity Type:Individual
Prefix:MR
First Name:EFREM
Middle Name:GLENN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 11TH AVE. SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-939-4885
Mailing Address - Fax:205-417-2817
Practice Address - Street 1:1617 11TH AVE. SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-939-4885
Practice Address - Fax:205-417-2817
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-32156OtherBC/BS OF ALABAMA
AL82868Medicare UPIN