Provider Demographics
NPI:1619681863
Name:CASE CHIROPRACTIC NEUROLOGY CENTER LLC
Entity Type:Organization
Organization Name:CASE CHIROPRACTIC NEUROLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-576-1234
Mailing Address - Street 1:775 KINGSBAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3886
Mailing Address - Country:US
Mailing Address - Phone:912-576-1234
Mailing Address - Fax:912-510-5000
Practice Address - Street 1:775 KINGSBAY RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3886
Practice Address - Country:US
Practice Address - Phone:912-576-1234
Practice Address - Fax:912-510-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty