Provider Demographics
NPI:1851723274
Name:MODERN CHIROPRACTIC
Entity Type:Organization
Organization Name:MODERN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-621-2221
Mailing Address - Street 1:377 HUNTLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-6164
Mailing Address - Country:US
Mailing Address - Phone:205-621-2221
Mailing Address - Fax:
Practice Address - Street 1:377 HUNTLEY PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-6164
Practice Address - Country:US
Practice Address - Phone:205-621-2221
Practice Address - Fax:205-663-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty