Provider Demographics
NPI:1275932493
Name:SOUTH GEORGIA CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTH GEORGIA CHIROPRACTIC
Other - Org Name:TRI-COUNTY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:REUSCHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-538-0708
Mailing Address - Street 1:511 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4738
Mailing Address - Country:US
Mailing Address - Phone:912-538-0708
Mailing Address - Fax:912-538-8318
Practice Address - Street 1:362 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0104
Practice Address - Country:US
Practice Address - Phone:912-538-0708
Practice Address - Fax:912-538-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I352237Medicare PIN