Provider Demographics
NPI:1831244276
Name:ASSOCIATED FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:ASSOCIATED FAMILY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-350-1166
Mailing Address - Street 1:1000 BELTLINE RD SW
Mailing Address - Street 2:SUITE V-1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6262
Mailing Address - Country:US
Mailing Address - Phone:256-350-1166
Mailing Address - Fax:256-350-5744
Practice Address - Street 1:1000 BELTLINE RD SW
Practice Address - Street 2:SUITE V-1
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6262
Practice Address - Country:US
Practice Address - Phone:256-350-1166
Practice Address - Fax:256-350-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL72542OtherBC BS
AL51072542Medicare ID - Type Unspecified
ALT87989Medicare UPIN