Provider Demographics
NPI:1033130851
Name:DAVID L SELDEN PC
Entity Type:Organization
Organization Name:DAVID L SELDEN PC
Other - Org Name:ETOWAH CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-479-4918
Mailing Address - Street 1:2905 MARIETTA HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8325
Mailing Address - Country:US
Mailing Address - Phone:770-479-4918
Mailing Address - Fax:770-479-4918
Practice Address - Street 1:2905 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8325
Practice Address - Country:US
Practice Address - Phone:770-479-4918
Practice Address - Fax:770-479-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROO2770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700426Medicare PIN