Provider Demographics
NPI:1326053869
Name:ADVANCED CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CLINIC PC
Other - Org Name:PERKINS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-957-6808
Mailing Address - Street 1:3232 KRISAM CREEK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7992
Mailing Address - Country:US
Mailing Address - Phone:678-957-6808
Mailing Address - Fax:678-957-6810
Practice Address - Street 1:3232 KRISAM CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7992
Practice Address - Country:US
Practice Address - Phone:678-957-6808
Practice Address - Fax:678-957-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 006378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU80559Medicare UPIN
GA35ZCFZSMedicare ID - Type Unspecified