| Name: | Alabama Family Chiropractic Clinic, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 Jun 2006 (18 years ago) |
| Entity Number: | 000-480-130 |
| Register Number: | 000480130 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 1714 W THIRD STMONTGOMERY, AL 36106 |
| Registered Office Street Address ZIP Code: | 36106 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952623316 | 2010-02-25 | 2010-02-25 | 1714 W 3RD ST, MONTGOMERY, AL, 361061506, US | 1714 W 3RD ST, MONTGOMERY, AL, 361061506, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-834-6282 |
| Fax | 3348346418 |
Authorized person
| Name | MRS. SUSAN HENRY |
| Role | BILLING PROFESSIONAL |
| Phone | 3343966988 |
Taxonomy
| Taxonomy Code | 111NN1001X - Nutrition Chiropractor |
| License Number | 1762 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF ALABAMA |
| Number | 51035505 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529902520 |
| State | AL |
| Issuer | BCBS OF ALABAMA |
| Number | 51097398 |
| State | AL |
| Name | Role |
|---|---|
| RUSSELL, LEROY CURTIS | Agent |
| Name | Role |
|---|---|
| RUSSELL, LEROY CURTIS | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
