Provider Demographics
NPI:1689773608
Name:DR. WADE CLINGAN, D.C, P.C. AT FIRST CHOICE CHIROPRACTIC
Entity Type:Organization
Organization Name:DR. WADE CLINGAN, D.C, P.C. AT FIRST CHOICE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:CLINGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,PC
Authorized Official - Phone:334-358-0320
Mailing Address - Street 1:550 MCQUEEN SMITH RD N
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5558
Mailing Address - Country:US
Mailing Address - Phone:334-358-0320
Mailing Address - Fax:334-358-8923
Practice Address - Street 1:550 MCQUEEN SMITH RD N
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5558
Practice Address - Country:US
Practice Address - Phone:334-358-0320
Practice Address - Fax:334-358-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000092791CL1Medicare ID - Type UnspecifiedMEDICARE
ALU85810Medicare UPIN