Provider Demographics
NPI:1326266388
Name:ENIX CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:ENIX CHIROPRACTIC CLINIC, LLC
Other - Org Name:SMYRNA INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ENIX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-955-3502
Mailing Address - Street 1:240 CHEROKEE ST NE STE 302
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1628
Mailing Address - Country:US
Mailing Address - Phone:770-955-3502
Mailing Address - Fax:770-874-7753
Practice Address - Street 1:736 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1860
Practice Address - Country:US
Practice Address - Phone:770-955-3502
Practice Address - Fax:770-874-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006401261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center