Provider Demographics
NPI:1588847552
Name:MARK W VANDINE
Entity Type:Organization
Organization Name:MARK W VANDINE
Other - Org Name:ACCIDENT AND INJURY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-251-3238
Mailing Address - Street 1:27 BULLSBORO DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1570
Mailing Address - Country:US
Mailing Address - Phone:770-251-3238
Mailing Address - Fax:770-251-5340
Practice Address - Street 1:27 BULLSBORO DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1570
Practice Address - Country:US
Practice Address - Phone:770-251-3238
Practice Address - Fax:770-251-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO1988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006501OtherMEDICARE GROUP NUMBER
GA35ZCHTPMedicare PIN