Provider Demographics
NPI:1992956593
Name:SOUTHSIDE CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:SOUTHSIDE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-933-8373
Mailing Address - Street 1:920 18TH ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3700
Mailing Address - Country:US
Mailing Address - Phone:205-933-8373
Mailing Address - Fax:205-278-8718
Practice Address - Street 1:920 18TH ST S
Practice Address - Street 2:SUITE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3700
Practice Address - Country:US
Practice Address - Phone:205-933-8373
Practice Address - Fax:205-278-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty