Provider Demographics
NPI:1295032175
Name:WOODPARK FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WOODPARK FAMILY CHIROPRACTIC LLC
Other - Org Name:FOOTHILLS CHIROPRACTIC & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUHAIF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-926-9495
Mailing Address - Street 1:310 GOLD CREEK TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5436
Mailing Address - Country:US
Mailing Address - Phone:770-926-9495
Mailing Address - Fax:770-926-9284
Practice Address - Street 1:203 WOODPARK PL STE B100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3758
Practice Address - Country:US
Practice Address - Phone:770-926-9495
Practice Address - Fax:770-926-9284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty