Provider Demographics
NPI:1912297730
Name:MAGIC CITY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MAGIC CITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-602-2117
Mailing Address - Street 1:3049 HIGHWAY 150 SOUTH, SUITE 116
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-444-4844
Mailing Address - Fax:205-444-4846
Practice Address - Street 1:3049 HIGHWAY 150 STE 116
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1084
Practice Address - Country:US
Practice Address - Phone:205-444-4844
Practice Address - Fax:205-444-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty