Individual
DR. ANTHONY SHANE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1491 HARTFORD HWY, DOTHAN, AL 36301-3349
(334) 673-1488
(334) 673-8798
Mailing address
PO BOX 6853, DOTHAN, AL 36302-6853
(334) 673-1488
(334) 673-8798
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1638
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497724645
NPI
AL
01
—
350045914
RAILROAD MEDICARE PALMETTO
AL
01
—
51078506
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/17/2006
Last updated
09/09/2013
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