Provider Demographics
NPI:1265701122
Name:HEALTHSOURCE OF HARVEST
Entity type:Organization
Organization Name:HEALTHSOURCE OF HARVEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-852-2000
Mailing Address - Street 1:5850 HWY 53
Mailing Address - Street 2:SUITE N
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-4302
Mailing Address - Country:US
Mailing Address - Phone:256-852-2000
Mailing Address - Fax:256-852-2232
Practice Address - Street 1:5850 HIGHWAY 53
Practice Address - Street 2:STE. N
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-4301
Practice Address - Country:US
Practice Address - Phone:256-852-2000
Practice Address - Fax:256-852-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL#2111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty