1891098018 NPI number — DEGRAAF CHIROPRACTIC ASSOCIATES, INC.

Table of content: MS. EBONY KEMYATTA BAILEY MA (NPI 1427197797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891098018 NPI number — DEGRAAF CHIROPRACTIC ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEGRAAF CHIROPRACTIC ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891098018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 BRISTLECONE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-840-0344
Provider Business Mailing Address Fax Number:
706-560-0181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 PEACH ORCHARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30906-2388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-560-0180
Provider Business Practice Location Address Fax Number:
706-560-0181
Provider Enumeration Date:
12/09/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KALENSKY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
706-560-0180

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR005062 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 35ZCFHG . This is a "UNSPECIFIED" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".