Provider Demographics
NPI:1194183491
Name:CHATHAM CHIROPRACTIC & INTEGRATED HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CHATHAM CHIROPRACTIC & INTEGRATED HEALTH SERVICES, LLC
Other - Org Name:CHATHAM CLINICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-429-5966
Mailing Address - Street 1:400 MALL BLVD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4861
Mailing Address - Country:US
Mailing Address - Phone:912-429-5966
Mailing Address - Fax:912-353-5747
Practice Address - Street 1:400 MALL BLVD
Practice Address - Street 2:SUITE 1C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4861
Practice Address - Country:US
Practice Address - Phone:912-429-5966
Practice Address - Fax:912-353-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111N00000X
SC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U45129Medicare UPIN