NPIMap

Organization Active NPI

Eastern Shore Chiropractic & Sports Clinic, Inc

  • Chiropractor
  • Fairhope, AL
National Provider Identifier
1679809644
Registry record updated Oct 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2292 Issued in AL
Legal business name
EASTERN SHORE CHIROPRACTIC & SPORTS CLINIC, INC
Practice address
151 Fly Creek Avenue
Suite 411
Fairhope, AL 36532-3843
Phone
(225) 274-5507
NPI assigned
Oct 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justin Fisher Southall, D.C.NPI 1346403557
Title
President/Owner
Phone
(225) 274-5507

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2292 AL Primary

Addresses

Primary practice location

151 Fly Creek Avenue
Suite 411
Fairhope, AL 36532-3843

Mailing address

151 Fly Creek Avenue
Suite 411
Fairhope, AL 36532-3843
Phone (225) 274-5507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091214000609 AL Part B Supplier - Clinic/Group Practice 8729128228 Receives reassigned benefits from 3 practitioners
Practice locations: Fairhope, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256601600000",
    "number": "1679809644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 FLY CREEK AVENUE",
            "address_2": "SUITE 411",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365323843",
            "telephone_number": "225-274-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 FLY CREEK AVENUE",
            "address_2": "SUITE 411",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365323843",
            "telephone_number": "225-274-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE CHIROPRACTIC & SPORTS CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-27",
        "last_updated": "2009-10-27",
        "status": "A",
        "authorized_official_last_name": "SOUTHALL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "FISHER",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "225-274-5507",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AL",
            "license": "2292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairhope, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.