Provider Demographics
NPI:1124324306
Name:COOSA VALLEY CHIROPRACTIC CENTER,INC.
Entity type:Organization
Organization Name:COOSA VALLEY CHIROPRACTIC CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-245-0404
Mailing Address - Street 1:11 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2939
Mailing Address - Country:US
Mailing Address - Phone:256-245-0404
Mailing Address - Fax:256-245-0404
Practice Address - Street 1:11 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2939
Practice Address - Country:US
Practice Address - Phone:256-245-0404
Practice Address - Fax:256-245-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000072029Medicare PIN
ALT92665Medicare UPIN