Provider Demographics
NPI:1235158478
Name:CHELEKIS, ERIC GLEN (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GLEN
Last Name:CHELEKIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0069
Mailing Address - Country:US
Mailing Address - Phone:770-961-5577
Mailing Address - Fax:770-961-1407
Practice Address - Street 1:1630 PLEASANT HILL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5899
Practice Address - Country:US
Practice Address - Phone:770-923-9050
Practice Address - Fax:770-279-8379
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGSQMedicare ID - Type Unspecified
GAU89679Medicare UPIN
GAGRP1288Medicare ID - Type UnspecifiedGROUP NUMBER