Provider Demographics
NPI:1154499101
Name:BEARDEN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BEARDEN CHIROPRACTIC CENTER
Other - Org Name:MANNELLA CHIROPRACTIC, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-374-1111
Mailing Address - Street 1:5633 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-5638
Mailing Address - Country:US
Mailing Address - Phone:478-374-1111
Mailing Address - Fax:478-374-1913
Practice Address - Street 1:5633 OAK ST
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-5638
Practice Address - Country:US
Practice Address - Phone:478-374-1111
Practice Address - Fax:478-374-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty