| Name: | Southeastern Chiropractic Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 05 Aug 1998 (26 years ago) |
| Entity Number: | 000-197-047 |
| Register Number: | 000197047 |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 1910 ROSS CLARK CIRCLE STE 2DOTHAN, AL 36301 |
| Registered Office Street Address ZIP Code: | 36301 |
| Authorized Capital: | $1,000 |
Activities
CHIROPRACTIC SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508999392 | 2007-03-13 | 2013-09-09 | PO BOX 6853, DOTHAN, AL, 363026853, US | 1491 HARTFORD HWY, DOTHAN, AL, 363013349, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 334-673-1488 |
| Fax | 3346738798 |
Authorized person
| Name | ROBBIE ANN MULLEN |
| Role | INSURANCE MANAGER |
| Phone | 3346731488 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1497724645 |
| State | AL |
| Issuer | RAILROAD MEDICARE PALMETT |
| Number | 350045914 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51078506 |
| State | AL |
| Name | Role |
|---|---|
| BLACK, ANTHONY S | Agent |
| Name | Role | Address |
|---|---|---|
| WALTERS, CHASE | Director | 314 BRUSHFIRE DRIVEDOTHAN, AL 36305 |
| Name | Role |
|---|---|
| BLACK, ANTHONY SHANE | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
