Provider Demographics
NPI:1982870630
Name:HUEYTOWN CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:HUEYTOWN CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEFRANCO
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:205-491-6881
Mailing Address - Street 1:3166 ALLISON BONNETT MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-1641
Mailing Address - Country:US
Mailing Address - Phone:205-491-6881
Mailing Address - Fax:205-491-6881
Practice Address - Street 1:3166 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1641
Practice Address - Country:US
Practice Address - Phone:205-491-6881
Practice Address - Fax:205-491-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68393OtherUPIN
AL44788OtherBLUE CROSS BLUE SHIELD
ALK313OtherMEDICARE