Provider Demographics
NPI:1760682322
Name:ASSOCIATED CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:ASSOCIATED CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-847-8477
Mailing Address - Street 1:80 SPRING BRANCH RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-7311
Mailing Address - Country:US
Mailing Address - Phone:256-847-8477
Mailing Address - Fax:256-847-8475
Practice Address - Street 1:80 SPRING BRANCH RD
Practice Address - Street 2:SUITE E
Practice Address - City:ALEXANDRIA
Practice Address - State:AL
Practice Address - Zip Code:36250-7311
Practice Address - Country:US
Practice Address - Phone:256-847-8477
Practice Address - Fax:256-847-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1275532061OtherNPI