Provider Demographics
NPI:1457504367
Name:HESS CHIROPRACTIC LIFE CENTER INC.
Entity Type:Organization
Organization Name:HESS CHIROPRACTIC LIFE CENTER INC.
Other - Org Name:JEREMY A HESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-389-4744
Mailing Address - Street 1:5532 N HENRY BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3220
Mailing Address - Country:US
Mailing Address - Phone:770-389-4744
Mailing Address - Fax:770-979-2275
Practice Address - Street 1:5532 N HENRY BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3220
Practice Address - Country:US
Practice Address - Phone:770-389-4744
Practice Address - Fax:770-979-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty