Provider Demographics
NPI:1851758585
Name:CHELSEA CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:CHELSEA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-678-1000
Mailing Address - Street 1:398 CHESSER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8305
Mailing Address - Country:US
Mailing Address - Phone:205-678-1000
Mailing Address - Fax:205-678-1001
Practice Address - Street 1:398 CHESSER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8305
Practice Address - Country:US
Practice Address - Phone:205-678-1000
Practice Address - Fax:205-678-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051525708FOGMedicare PIN