Provider Demographics
NPI:1538703137
Name:GG CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GG CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GEADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-650-5336
Mailing Address - Street 1:PO BOX 2818
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-2818
Mailing Address - Country:US
Mailing Address - Phone:704-840-0760
Mailing Address - Fax:803-286-4604
Practice Address - Street 1:8811 BLAKENEY PROFESSIONAL DR STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6599
Practice Address - Country:US
Practice Address - Phone:704-840-0760
Practice Address - Fax:803-286-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty