Provider Demographics
NPI:1003097767
Name:SHERWOOD CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SHERWOOD CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE EXPERT
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-321-6997
Mailing Address - Street 1:1275 MCCONNELL DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3505
Mailing Address - Country:US
Mailing Address - Phone:404-321-0082
Mailing Address - Fax:404-321-2007
Practice Address - Street 1:1275 MCCONNELL DR
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3505
Practice Address - Country:US
Practice Address - Phone:404-321-0082
Practice Address - Fax:404-321-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA144084Medicare PIN
GA35ZCDZJMedicare UPIN