Organization
EASTERN SHORE CHIROPRACTIC & SPORTS CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN FISHER SOUTHALL D.C. (PRESIDENT/OWNER)
(225) 274-5507
Entity
Organization
Contact information
Practice address
151 FLY CREEK AVENUE, SUITE 411, FAIRHOPE, AL 36532-3843
(225) 274-5507
Mailing address
151 FLY CREEK AVENUE, SUITE 411, FAIRHOPE, AL 36532-3843
(225) 274-5507
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2292
AL
Other
Enumeration date
10/27/2009
Last updated
10/27/2009
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