Provider Demographics
NPI:1841566205
Name:HEALTHSOURCE OF MOBILE 1 LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF MOBILE 1 LLC
Other - Org Name:HEALTHSOURCE OF WEST MOBILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DC
Authorized Official - Prefix:MS
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-597-8832
Mailing Address - Street 1:740 SCHILLINGER RD S
Mailing Address - Street 2:STE 2B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8931
Mailing Address - Country:US
Mailing Address - Phone:251-633-3839
Mailing Address - Fax:251-633-4481
Practice Address - Street 1:740 SCHILLINGER RD S
Practice Address - Street 2:STE 2B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-8931
Practice Address - Country:US
Practice Address - Phone:251-633-3839
Practice Address - Fax:251-633-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty