Provider Demographics
NPI:1235460247
Name:VANCE, AUGUST (DC)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:
Last Name:VANCE
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 1:2300 SHALLOWFORD RD STE 8
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2075
Mailing Address - Country:US
Mailing Address - Phone:678-549-4863
Mailing Address - Fax:
Practice Address - Street 1:2300 SHALLOWFORD RD STE 8
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2075
Practice Address - Country:US
Practice Address - Phone:678-549-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHR008402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor