Provider Demographics
NPI:1710354329
Name:HUNTSVILLE SPINE AND REHAB
Entity Type:Organization
Organization Name:HUNTSVILLE SPINE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-519-3550
Mailing Address - Street 1:303 WILLIAMS AVENUE SW
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6001
Mailing Address - Country:US
Mailing Address - Phone:256-519-3550
Mailing Address - Fax:256-513-4890
Practice Address - Street 1:303 WILLIAMS AVE SW
Practice Address - Street 2:SUITE 117
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6012
Practice Address - Country:US
Practice Address - Phone:256-519-3550
Practice Address - Fax:256-513-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty