| Name: | Petry Chiropractic Center, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 28 Jun 2002 (22 years ago) (Companies founded in June 2002) |
| Date of dissolution: | 01 Oct 2013 |
| Entity Number: | 000-683-127 |
| Register Number: | 000683127 |
| ZIP code: | 35951 (Companies in Marshall, 35951) |
| County: | Marshall |
| Place of Formation: | Marshall County |
| Principal Address: | ALBERTVILLE, AL |
| Registered Office Street Address: | 700 AL HIGHWAY 75 NALBERTVILLE, AL 35951 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023383163 | 2012-03-21 | 2012-03-21 | 700 AL HIGHWAY 75 N, ALBERTVILLE, AL, 359514014, US | 700 AL HIGHWAY 75 N, ALBERTVILLE, AL, 359514014, US | |||||||||||||||||||||||||
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| Phone | +1 256-891-3733 |
| Fax | 2568910602 |
Authorized person
| Name | DR. EDDIE P PETRY |
| Role | OWNER |
| Phone | 2568913733 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | 1566 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51518312 |
| State | AL |
| Name | Role |
|---|---|
| PETRY, ED P | Agent |
| Name | Role |
|---|---|
| PETRY, ED P | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
