Provider Demographics
NPI:1235421819
Name:WILBERT FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WILBERT FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-944-0911
Mailing Address - Street 1:1757 EAST W CONNECTOR STE 4
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1251
Mailing Address - Country:US
Mailing Address - Phone:770-944-0911
Mailing Address - Fax:770-944-1892
Practice Address - Street 1:1757 EAST W CONNECTOR STE 4
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1251
Practice Address - Country:US
Practice Address - Phone:770-944-0911
Practice Address - Fax:770-944-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFZVMedicare PIN