Provider Demographics
NPI:1568637585
Name:FLACK, BETH ANNE (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:BETH ANNE
Middle Name:
Last Name:FLACK
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:DR
Other - First Name:BETH ANNE
Other - Middle Name:
Other - Last Name:HORNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, ATC
Mailing Address - Street 1:4246 WASHINGTON RD
Mailing Address - Street 2:STE 6
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3345
Mailing Address - Country:US
Mailing Address - Phone:706-305-3241
Mailing Address - Fax:706-922-7795
Practice Address - Street 1:4246 WASHINGTON RD STE 6
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3345
Practice Address - Country:US
Practice Address - Phone:706-305-3241
Practice Address - Fax:706-738-6353
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014402255A2300X
GACHIRO008359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I350153Medicare PIN