Provider Demographics
NPI:1104046044
Name:URBAN FAMILY CHIROPRACTIC LIFE CTR
Entity Type:Organization
Organization Name:URBAN FAMILY CHIROPRACTIC LIFE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-963-6711
Mailing Address - Street 1:PO BOX 23196
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403
Mailing Address - Country:US
Mailing Address - Phone:912-963-6711
Mailing Address - Fax:912-963-6713
Practice Address - Street 1:10 HARRELL DRIVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408
Practice Address - Country:US
Practice Address - Phone:912-963-6711
Practice Address - Fax:912-963-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05811111N00000X
GACHIRO05449111N00000X
SC1934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHSNMedicare ID - Type Unspecified
GAU60967Medicare UPIN
GA35ZCHFVMedicare ID - Type Unspecified
GAU93975Medicare UPIN