Provider Demographics
NPI:1952623316
Name:ALABAMA FAMILY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ALABAMA FAMILY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING PROFESSIONAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-396-6988
Mailing Address - Street 1:1714 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1506
Mailing Address - Country:US
Mailing Address - Phone:334-834-6282
Mailing Address - Fax:334-834-6418
Practice Address - Street 1:1714 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1506
Practice Address - Country:US
Practice Address - Phone:334-834-6282
Practice Address - Fax:334-834-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1762111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51035505OtherBCBS OF ALABAMA
AL529902520Medicaid
AL51097398OtherBCBS OF ALABAMA
AL51035505OtherBCBS OF ALABAMA
AL51097398OtherBCBS OF ALABAMA