1508999392 NPI number — SOUTHEASTERN CHIROPRACTIC ASSOCIATES,P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508999392 NPI number — SOUTHEASTERN CHIROPRACTIC ASSOCIATES,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN CHIROPRACTIC ASSOCIATES,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508999392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6853
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36302-6853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-673-1488
Provider Business Mailing Address Fax Number:
334-673-8798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1491 HARTFORD HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-673-1488
Provider Business Practice Location Address Fax Number:
334-673-8798
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MULLEN
Authorized Official First Name:
ROBBIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
INSURANCE MANAGER
Authorized Official Telephone Number:
334-673-1488

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497724645 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 350045914 . This is a "RAILROAD MEDICARE PALMETT" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51078506 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com