Provider Demographics
NPI:1770806366
Name:WADE CLINIC OF CHIROPRACTIC, PC
Entity type:Organization
Organization Name:WADE CLINIC OF CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-237-9423
Mailing Address - Street 1:620 QUINTARD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1840
Mailing Address - Country:US
Mailing Address - Phone:256-237-9423
Mailing Address - Fax:256-237-6007
Practice Address - Street 1:620 QUINTARD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1840
Practice Address - Country:US
Practice Address - Phone:256-237-9423
Practice Address - Fax:256-237-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1059261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000070824OtherMEDICARE IDENTIFICATION NUMBER