Provider Demographics
NPI:1568527455
Name:GEORGIA CHIROPRACTIC GROUP LLC
Entity Type:Organization
Organization Name:GEORGIA CHIROPRACTIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LECROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-388-7670
Mailing Address - Street 1:12926 HIGHWAY 92
Mailing Address - Street 2:STE 900
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5195
Mailing Address - Country:US
Mailing Address - Phone:678-388-7670
Mailing Address - Fax:678-388-7671
Practice Address - Street 1:12926 HIGHWAY 92
Practice Address - Street 2:STE 900
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5195
Practice Address - Country:US
Practice Address - Phone:678-388-7670
Practice Address - Fax:678-388-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty