Provider Demographics
NPI:1780196030
Name:EVERGREEN FAMILY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:EVERGREEN FAMILY CHIROPRACTIC CLINIC
Other - Org Name:EVERGREEN FAMILY CHIROPRACTIC ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONGHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-937-6287
Mailing Address - Street 1:7910 MEMORIAL PKWY SW STE E
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2260
Mailing Address - Country:US
Mailing Address - Phone:678-392-6273
Mailing Address - Fax:
Practice Address - Street 1:7910 MEMORIAL PKWY SW STE E
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2260
Practice Address - Country:US
Practice Address - Phone:678-392-6273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty