Provider Demographics
NPI:1689814543
Name:HOMETOWN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HOMETOWN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-225-1381
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-0215
Mailing Address - Country:US
Mailing Address - Phone:205-225-1381
Mailing Address - Fax:
Practice Address - Street 1:204 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-9380
Practice Address - Country:US
Practice Address - Phone:205-225-1381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGZPMedicare PIN
GAU92423Medicare UPIN