Provider Demographics
NPI:1295125490
Name:CHIROPRACTIC CARE, INC.
Entity type:Organization
Organization Name:CHIROPRACTIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-968-2000
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-0899
Mailing Address - Country:US
Mailing Address - Phone:251-968-2000
Mailing Address - Fax:251-968-5953
Practice Address - Street 1:3533 GULF SHORES PARKWAY
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-968-2000
Practice Address - Fax:251-968-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1851490981OtherSOLE PROP NPI - PRIOR TO INCORPORATION
11423356OtherCAQH
5841240001Medicare NSC
AL000070833Medicare PIN