Provider Demographics
NPI:1528236171
Name:PA CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:PA CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:LILLIEANN
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-845-0528
Mailing Address - Street 1:1951 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3417
Mailing Address - Country:US
Mailing Address - Phone:256-845-0528
Mailing Address - Fax:256-845-5123
Practice Address - Street 1:1951 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3417
Practice Address - Country:US
Practice Address - Phone:256-845-0528
Practice Address - Fax:256-845-5123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty