Provider Demographics
NPI:1558540906
Name:PAUL A CHANDLER DC PC
Entity Type:Organization
Organization Name:PAUL A CHANDLER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-772-6300
Mailing Address - Street 1:4825 ATLANTA HWY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3946
Mailing Address - Country:US
Mailing Address - Phone:770-772-6300
Mailing Address - Fax:770-772-6307
Practice Address - Street 1:4825 ATLANTA HWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3946
Practice Address - Country:US
Practice Address - Phone:770-772-6300
Practice Address - Fax:770-772-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU11763Medicare UPIN
GAGRP7131Medicare PIN