Provider Demographics
NPI:1033637533
Name:ONE HUNDRED PERCENT CHIROPRACTIC ATLANTA EIGHT
Entity Type:Organization
Organization Name:ONE HUNDRED PERCENT CHIROPRACTIC ATLANTA EIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSOM JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-919-4545
Mailing Address - Street 1:4516 HUNTERS WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2553
Mailing Address - Country:US
Mailing Address - Phone:404-536-4267
Mailing Address - Fax:
Practice Address - Street 1:4490 CHAMBLEE DUNWOODY RD STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6237
Practice Address - Country:US
Practice Address - Phone:770-457-1571
Practice Address - Fax:770-457-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty