Provider Demographics
NPI:1316300189
Name:DEKALB FOOT CLINIC
Entity type:Organization
Organization Name:DEKALB FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-717-6610
Mailing Address - Street 1:2202 JORDAN RD SW
Mailing Address - Street 2:SUITE 500A
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3691
Mailing Address - Country:US
Mailing Address - Phone:256-845-3045
Mailing Address - Fax:256-845-3046
Practice Address - Street 1:2202 JORDAN RD SW
Practice Address - Street 2:SUITE 500A
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3691
Practice Address - Country:US
Practice Address - Phone:256-845-3045
Practice Address - Fax:256-845-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU55995Medicare UPIN