1144304171 NPI number — GENERAL CHIROPRACTIC, P.C.

Table of content: (NPI 1144304171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144304171 NPI number — GENERAL CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERAL CHIROPRACTIC, P.C.
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:
6
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:
1144304171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3760 SIXES RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30114-8192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-704-4580
Provider Business Mailing Address Fax Number:
770-704-9142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3760 SIXES RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114-8192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-704-4580
Provider Business Practice Location Address Fax Number:
770-704-9142
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHADLER
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
770-704-4580

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR005505 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: CHIR005639 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GRP5011 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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