Provider Demographics
NPI:1609150705
Name:HARDISON FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:HARDISON FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-850-5595
Mailing Address - Street 1:1020 BARBER CREEK DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5981
Mailing Address - Country:US
Mailing Address - Phone:706-850-5595
Mailing Address - Fax:706-850-5883
Practice Address - Street 1:1020 BARBER CREEK DR
Practice Address - Street 2:SUITE 310
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5981
Practice Address - Country:US
Practice Address - Phone:706-850-5595
Practice Address - Fax:706-850-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1417132531OtherPROVIDER NPI