Provider Demographics
NPI:1669784211
Name:SOUTH PARKWAY CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTH PARKWAY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:REED
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:256-519-8972
Mailing Address - Street 1:PO BOX 22583
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-2583
Mailing Address - Country:US
Mailing Address - Phone:256-519-8972
Mailing Address - Fax:256-534-3722
Practice Address - Street 1:2608 ARTIE ST SW STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4743
Practice Address - Country:US
Practice Address - Phone:256-519-8972
Practice Address - Fax:256-534-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty