Provider Demographics
NPI:1205005790
Name:LEDOUX CHIROPRACTIC CENTER, D.C. , P,C.
Entity Type:Organization
Organization Name:LEDOUX CHIROPRACTIC CENTER, D.C. , P,C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEDOUX
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:770-722-0346
Mailing Address - Street 1:676 ASHLEY FOREST DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-6378
Mailing Address - Country:US
Mailing Address - Phone:770-722-0346
Mailing Address - Fax:770-592-1191
Practice Address - Street 1:4290 BELLS FERRY RD NW
Practice Address - Street 2:SUITE 118
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:770-722-0346
Practice Address - Fax:770-592-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCZZMedicare PIN
GAU56356Medicare UPIN