Provider Demographics
NPI:1629882121
Name:HEALTHSOURCE OF MERIDIANVILLE
Entity type:Organization
Organization Name:HEALTHSOURCE OF MERIDIANVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-874-2643
Mailing Address - Street 1:11850 HIGHWAY 231 431 N STE J
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2126
Mailing Address - Country:US
Mailing Address - Phone:217-381-7825
Mailing Address - Fax:
Practice Address - Street 1:11850 HIGHWAY 231 431 N STE J
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-2126
Practice Address - Country:US
Practice Address - Phone:217-381-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty