Provider Demographics
NPI:1538323589
Name:CENTER FOR FAMILY HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CENTER FOR FAMILY HEALTH AND WELLNESS, LLC
Other - Org Name:SLOCUM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:229-386-8800
Mailing Address - Street 1:416 TIFT AVE N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4466
Mailing Address - Country:US
Mailing Address - Phone:229-386-8800
Mailing Address - Fax:229-382-0739
Practice Address - Street 1:416 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4466
Practice Address - Country:US
Practice Address - Phone:229-386-8800
Practice Address - Fax:229-382-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBSCMedicare UPIN