Provider Demographics
NPI:1508242371
Name:FIRST CHOICE CHIROPRACTIC
Entity Type:Organization
Organization Name:FIRST CHOICE CHIROPRACTIC
Other - Org Name:JARRED COLEGROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARRED
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:COLEGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-535-0550
Mailing Address - Street 1:1335 JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1725
Mailing Address - Country:US
Mailing Address - Phone:770-535-0550
Mailing Address - Fax:770-535-1007
Practice Address - Street 1:1335 JUANITA AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1725
Practice Address - Country:US
Practice Address - Phone:770-535-0550
Practice Address - Fax:770-535-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11303748OtherCAQH
GA202I358966OtherMEDICARE PTAN
GA11303748OtherCAQH