Provider Demographics
NPI:1477272417
Name:NORTH GEORGIA UPPER CERVICAL CLINICS
Entity Type:Organization
Organization Name:NORTH GEORGIA UPPER CERVICAL CLINICS
Other - Org Name:FULLNESS OF LIFE CHIROPRACTIC CLINICS OF GA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:THANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-203-4489
Mailing Address - Street 1:955 SIMS HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:LULA
Mailing Address - State:GA
Mailing Address - Zip Code:30554-4026
Mailing Address - Country:US
Mailing Address - Phone:678-203-4489
Mailing Address - Fax:
Practice Address - Street 1:6110 BANKS ST
Practice Address - Street 2:
Practice Address - City:LULA
Practice Address - State:GA
Practice Address - Zip Code:30554-2858
Practice Address - Country:US
Practice Address - Phone:678-649-8569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty