Provider Demographics
NPI:1124204607
Name:CHESTNUT MOUNTAIN CHIROPRACTIC
Entity Type:Organization
Organization Name:CHESTNUT MOUNTAIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-532-2220
Mailing Address - Street 1:3703 WINDER HWY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3015
Mailing Address - Country:US
Mailing Address - Phone:770-532-2220
Mailing Address - Fax:
Practice Address - Street 1:3703 WINDER HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3015
Practice Address - Country:US
Practice Address - Phone:770-532-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6952111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU99853Medicare UPIN
GAGRP6454Medicare PIN