Provider Demographics
NPI:1750781308
Name:LORNA ROAD CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:LORNA ROAD CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-874-9790
Mailing Address - Street 1:3081 LORNA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4509
Mailing Address - Country:US
Mailing Address - Phone:205-874-9790
Mailing Address - Fax:205-874-9791
Practice Address - Street 1:3081 LORNA RD STE 104
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4509
Practice Address - Country:US
Practice Address - Phone:205-874-9790
Practice Address - Fax:205-874-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty