Provider Demographics
NPI:1548337652
Name:CRIMSON CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:CRIMSON CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-345-2009
Mailing Address - Street 1:2300 MCFARLAND BLVD E
Mailing Address - Street 2:SUITE 0A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5853
Mailing Address - Country:US
Mailing Address - Phone:205-345-2009
Mailing Address - Fax:
Practice Address - Street 1:2302 MCFARLAND BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5802
Practice Address - Country:US
Practice Address - Phone:205-345-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-73659OtherBCBS AL
AL000073659Medicare ID - Type UnspecifiedMEDICARE #