Provider Demographics
NPI:1043098817
Name:THE CHIRO PLACE OF DOUGLASVILLE PC
Entity Type:Organization
Organization Name:THE CHIRO PLACE OF DOUGLASVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-221-7173
Mailing Address - Street 1:8101 HACKS CROSS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4032
Mailing Address - Country:US
Mailing Address - Phone:901-221-7173
Mailing Address - Fax:662-932-8774
Practice Address - Street 1:4300 CHAPEL HILL RD STE 1200
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4238
Practice Address - Country:US
Practice Address - Phone:901-221-7173
Practice Address - Fax:662-932-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty