Provider Demographics
NPI:1245426097
Name:BILLINGSLEY & LUCKETT CHIROPRACTIC & REHAB. PC
Entity Type:Organization
Organization Name:BILLINGSLEY & LUCKETT CHIROPRACTIC & REHAB. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:770-760-1396
Mailing Address - Street 1:3289 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1863
Mailing Address - Country:US
Mailing Address - Phone:770-760-1396
Mailing Address - Fax:770-760-7904
Practice Address - Street 1:3289 SALEM RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1863
Practice Address - Country:US
Practice Address - Phone:770-760-1396
Practice Address - Fax:770-760-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001570111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6467Medicare PIN