Provider Demographics
NPI:1760546980
Name:DAPHNE CHIROPRACTIC CENTER,LLC
Entity Type:Organization
Organization Name:DAPHNE CHIROPRACTIC CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:MASHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-626-1234
Mailing Address - Street 1:9113 MERRITT LN
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5609
Mailing Address - Country:US
Mailing Address - Phone:251-626-1234
Mailing Address - Fax:
Practice Address - Street 1:9113 MERRITT LN
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5609
Practice Address - Country:US
Practice Address - Phone:251-626-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51507924OtherBCBS PROVIDER #
AL51507924OtherBCBS PROVIDER #
ALU30465Medicare UPIN