Provider Demographics
NPI:1861671075
Name:ALEX CITY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALEX CITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-234-4404
Mailing Address - Street 1:239 CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-2517
Mailing Address - Country:US
Mailing Address - Phone:256-234-4404
Mailing Address - Fax:256-234-4421
Practice Address - Street 1:239 CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-2517
Practice Address - Country:US
Practice Address - Phone:256-234-4404
Practice Address - Fax:256-234-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty