Provider Demographics
NPI:1003125907
Name:PAIGE M BLACK DC, LLP
Entity Type:Organization
Organization Name:PAIGE M BLACK DC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-266-2582
Mailing Address - Street 1:210 BUCK BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-4113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1066 KILLIAN HILL RD SW
Practice Address - Street 2:SUITE 103
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2306
Practice Address - Country:US
Practice Address - Phone:770-921-2830
Practice Address - Fax:770-921-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty