Provider Demographics
NPI:1699034090
Name:MONTGOMERY NECK AND BACK PAIN CENTER
Entity type:Organization
Organization Name:MONTGOMERY NECK AND BACK PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:334-272-3030
Mailing Address - Street 1:4171 LOMAC ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2945
Mailing Address - Country:US
Mailing Address - Phone:334-272-3030
Mailing Address - Fax:334-272-9912
Practice Address - Street 1:4171 LOMAC ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2945
Practice Address - Country:US
Practice Address - Phone:334-272-3030
Practice Address - Fax:334-272-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty