Provider Demographics
NPI:1770774846
Name:TOTAL REHAB CHIROPRACTIC LLC
Entity type:Organization
Organization Name:TOTAL REHAB CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:334-821-2256
Mailing Address - Street 1:2515 E GLENN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6453
Mailing Address - Country:US
Mailing Address - Phone:334-821-2256
Mailing Address - Fax:334-826-8082
Practice Address - Street 1:2515 E GLENN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6453
Practice Address - Country:US
Practice Address - Phone:334-821-2256
Practice Address - Fax:334-826-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51516578OtherBLUECROSS BLUESHIELD
ALT68499Medicare UPIN