Provider Demographics
NPI:1134642077
Name:CHIROPRACTIC HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTHCARE GROUP LLC
Other - Org Name:INDUSTRY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-649-2131
Mailing Address - Street 1:3000 WINDY HILL RD SE UNIT 674591
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3915 CASCADE RD SW STE T-155
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:678-648-2131
Practice Address - Fax:678-649-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-23
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009911111N00000X
GACHIR009897111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty