Provider Demographics
NPI:1669783734
Name:MADISON CHIROPRACTIC & NUTRITION CENTER, LLC
Entity type:Organization
Organization Name:MADISON CHIROPRACTIC & NUTRITION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-430-2700
Mailing Address - Street 1:PO BOX 21157
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35813-5157
Mailing Address - Country:US
Mailing Address - Phone:256-772-9949
Mailing Address - Fax:256-772-9947
Practice Address - Street 1:1908 SLAUGHTER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8619
Practice Address - Country:US
Practice Address - Phone:256-430-2700
Practice Address - Fax:256-430-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty