Provider Demographics
NPI:1225302920
Name:ATHENS CHIROPRACTIC HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ATHENS CHIROPRACTIC HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:GROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-227-3292
Mailing Address - Street 1:623 N MILLEDGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-3801
Mailing Address - Country:US
Mailing Address - Phone:706-227-3292
Mailing Address - Fax:888-809-9345
Practice Address - Street 1:623 N MILLEDGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-3801
Practice Address - Country:US
Practice Address - Phone:706-227-3292
Practice Address - Fax:888-809-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007566261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHSHMedicare PIN
GAV00118Medicare UPIN