Provider Demographics
NPI:1710027388
Name:CHRISTENBERRY CLINIC, P. C.
Entity Type:Organization
Organization Name:CHRISTENBERRY CLINIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHRISTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-492-5002
Mailing Address - Street 1:300 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1157
Mailing Address - Country:US
Mailing Address - Phone:256-492-5002
Mailing Address - Fax:256-492-5442
Practice Address - Street 1:300 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 402
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1157
Practice Address - Country:US
Practice Address - Phone:256-492-5002
Practice Address - Fax:256-492-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE97946Medicare UPIN