Provider Demographics
NPI:1013177104
Name:CENTAL BALDWIN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CENTAL BALDWIN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-947-9010
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-1044
Mailing Address - Country:US
Mailing Address - Phone:251-947-9010
Mailing Address - Fax:251-947-9011
Practice Address - Street 1:18557 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-3629
Practice Address - Country:US
Practice Address - Phone:251-947-9010
Practice Address - Fax:251-947-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034149Medicare PIN
ALU62994Medicare UPIN
AL510G700245Medicare PIN