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>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1376618793

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
5499 JONESBORO RD  LAKE CITY, GA 30260-3553 US
Tel: 404-363-6460  Fax: 404-363-4348

Contact information for business:
5499 JONESBORO RD  LAKE CITY, GA 30260-3553 US
Tel: 404-363-6460  Fax: 404-363-4348

Registration Information:
NPI: 1376618793
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers

Legacy codes, insurance codes and state license numbers:



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