Provider Demographics
NPI:1609190370
Name:EBERT, CHAZ (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAZ
Middle Name:
Last Name:EBERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 HOG MOUNTAIN RD
Mailing Address - Street 2:301
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4811
Mailing Address - Country:US
Mailing Address - Phone:708-267-4756
Mailing Address - Fax:
Practice Address - Street 1:2410 HOG MOUNTAIN RD
Practice Address - Street 2:STE. 301
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4811
Practice Address - Country:US
Practice Address - Phone:708-267-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008601111N00000X
WI4607-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor