Provider Demographics
NPI:1992841266
Name:TANKERSLEY CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:TANKERSLEY CHIROPRACTIC CLINIC P.C.
Other - Org Name:TANKERSLEY CHIROPRACTIC CLINIC P. C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:TANKERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-737-9999
Mailing Address - Street 1:2015 CHEROKEE AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5552
Mailing Address - Country:US
Mailing Address - Phone:256-737-9999
Mailing Address - Fax:
Practice Address - Street 1:2015 CHEROKEE AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5552
Practice Address - Country:US
Practice Address - Phone:256-737-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANKERSLEY CHIROPRACTIC CLINIC P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68591Medicare UPIN