Provider Demographics
NPI:1093021818
Name:CHIROPRACTIC WELLNESS CENTER P C
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-623-6880
Mailing Address - Street 1:6385 MCGINNIS FERRY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3672
Mailing Address - Country:US
Mailing Address - Phone:770-623-6880
Mailing Address - Fax:770-623-6440
Practice Address - Street 1:6385 MCGINNIS FERRY RD STE 201
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-3672
Practice Address - Country:US
Practice Address - Phone:770-623-6880
Practice Address - Fax:770-623-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty