Provider Demographics
NPI:1538220967
Name:SCHILLINGER ROAD CHIROPRACTIC
Entity type:Organization
Organization Name:SCHILLINGER ROAD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-635-1224
Mailing Address - Street 1:1516 SCHILLINGER RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8933
Mailing Address - Country:US
Mailing Address - Phone:251-635-1224
Mailing Address - Fax:
Practice Address - Street 1:1516 SCHILLINGER RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-8933
Practice Address - Country:US
Practice Address - Phone:251-635-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517785OtherBCBS
AL=========OtherALL OTHER INSURANCE
AL51517785OtherBCBS
AL051554080Medicare ID - Type Unspecified