is a Chiropractor in Huntsville, Alabama. practices all healthcare services and medical treatments related to Chiropractor. The NPI Number for is 1457518029. The last update date is .
's current location address is 2745 Bob Wallace Ave Sw, Huntsville, Alabama. You can contact this provider via phone number 2564896605 and fax number 2564896253. The mailing address for is 2745 Bob Wallace Ave Sw, Huntsville, Alabama. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2745 Bob Wallace Ave Sw, Huntsville, Alabama |
| Phone Number | 2564896605 |
| Fax Number | 2564896253 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1457518029 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2745 Bob Wallace Ave Sw |
|---|---|
| City | Huntsville |
| State | Alabama (AL) |
| Post Code | 358054158 |
| Phone Number | 2564896605 |
| Fax Number | 2564896253 |
Provider's Primary Taxonomy Detail
| Speciality | Chiropractor |
|---|---|
| Taxonomy | 111N00000X |
| Licence No | 1147 |
|
Definition: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its inte |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 510G700210 | AL | MEDICARE (CAHABA) PTAN | |
| P00644638 | AL | MEDICARE (RAILROAD) PTAN | |
| 515-45452 | AL | BCBS OF ALABAMA |
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