Provider Demographics
NPI:1073020749
Name:HARRELL, CHARLENE RICHMOND (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:RICHMOND
Last Name:HARRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:CORNELIA
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 ZELDA RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-395-5850
Mailing Address - Fax:334-271-4734
Practice Address - Street 1:2900 ZELDA RD.
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-395-5850
Practice Address - Fax:334-271-4734
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor