Provider Demographics
NPI:1902900475
Name:CHASE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CHASE CHIROPRACTIC CENTER
Other - Org Name:DR. BRIAN T. CLARK, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-859-0440
Mailing Address - Street 1:5175 MOORES MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811
Mailing Address - Country:US
Mailing Address - Phone:256-859-0440
Mailing Address - Fax:
Practice Address - Street 1:5175 MOORES MILL ROAD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811
Practice Address - Country:US
Practice Address - Phone:256-859-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68364Medicare UPIN