Provider Demographics
NPI:1568901353
Name:ISLANDS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ISLANDS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:COXHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-897-9360
Mailing Address - Street 1:461 JOHNNY MERCER BLVD. SUITE3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410
Mailing Address - Country:US
Mailing Address - Phone:912-897-9360
Mailing Address - Fax:912-898-0840
Practice Address - Street 1:461 JOHNNY MERCER BLVD. SUITE3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410
Practice Address - Country:US
Practice Address - Phone:912-897-9360
Practice Address - Fax:912-898-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3013302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1992876999Medicare UPIN
GA1992876999Medicare PIN