Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1502 | AL |
NPI | 1003995341 |
---|---|
Provider Name | Mr. Tony Max Hughes JR. |
First Address | Clanton, AL 35045-3749 |
Second Address | Clanton, AL 35045-3749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U34666 | (02) |