Provider Demographics
NPI:1144376328
Name:ALABAMA BACK PAIN CLINIC
Entity type:Organization
Organization Name:ALABAMA BACK PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-265-4800
Mailing Address - Street 1:1237 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1130
Mailing Address - Country:US
Mailing Address - Phone:334-265-4800
Mailing Address - Fax:334-265-1818
Practice Address - Street 1:1237 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1130
Practice Address - Country:US
Practice Address - Phone:334-265-4800
Practice Address - Fax:334-265-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68515Medicare UPIN