Provider Demographics
NPI:1548227929
Name:CHIROPRACTIC CENTER OF MARIETTA PC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF MARIETTA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANSON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GABY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-422-9288
Mailing Address - Street 1:1135 S MARIETTA PKWY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2811
Mailing Address - Country:US
Mailing Address - Phone:770-422-9288
Mailing Address - Fax:770-422-4626
Practice Address - Street 1:1135 S MARIETTA PKWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2811
Practice Address - Country:US
Practice Address - Phone:770-422-9288
Practice Address - Fax:770-422-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP576Medicare ID - Type Unspecified