Provider Demographics
NPI:1225554678
Name:PIERCE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:PIERCE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-920-0228
Mailing Address - Street 1:741 MOROSGO DR NE APT 1523
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3544
Mailing Address - Country:US
Mailing Address - Phone:407-920-0228
Mailing Address - Fax:
Practice Address - Street 1:1409 N HIGHLAND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3300
Practice Address - Country:US
Practice Address - Phone:407-920-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty