Provider Demographics
NPI:1245409697
Name:DAVIS CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:DAVIS CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-486-9169
Mailing Address - Street 1:271 HIGHWAY 74 N STE 1
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1470
Mailing Address - Country:US
Mailing Address - Phone:770-486-9169
Mailing Address - Fax:770-486-9145
Practice Address - Street 1:271 HIGHWAY 74 N
Practice Address - Street 2:SUITE 1
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1470
Practice Address - Country:US
Practice Address - Phone:770-486-9169
Practice Address - Fax:770-486-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU69309Medicare UPIN
GAU94985Medicare UPIN