| Name: | Central Alabama Spine Center, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 08 Jun 2009 (15 years ago) |
| Entity Number: | 000-434-694 |
| Register Number: | 000434694 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 1608 HAVEN DRBIRMINGHAM, AL 35214 |
| Registered Office Street Address ZIP Code: | 35214 |
Activities
CHIROPRACTIC SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649407446 | 2009-06-18 | 2012-01-10 | PO BOX 1198, TRUSSVILLE, AL, 351736100, US | 52 MEDICAL PARK DR E, SUITE 219, BIRMINGHAM, AL, 352353430, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-655-2277 |
| Fax | 2056556037 |
Authorized person
| Name | DR. DESHAN SHERARD GROSS |
| Role | MEMBER |
| Phone | 2056552277 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | 2065 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | 1151 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 7009708 |
| State | AL |
| Issuer | LEGACY |
| Number | P00292774 |
| State | AL |
| Issuer | NPI |
| Number | 1972652865 |
| State | AL |
| Issuer | AETNA |
| Number | 4408799 |
| State | AL |
| Issuer | NPI |
| Number | 1215086103 |
| State | AL |
| Issuer | LEGACY |
| Number | P00263210 |
| State | AL |
| Name | Role |
|---|---|
| GROSS, DESHAN | Member |
| Name | Role |
|---|---|
| GROSS, DESHAN | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
