Provider Demographics
NPI:1639733041
Name:CROSSROADS WELLNESS PC
Entity Type:Organization
Organization Name:CROSSROADS WELLNESS PC
Other - Org Name:CENTRAL GEORGIA CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:478-268-9011
Mailing Address - Street 1:120 JACKSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3160
Mailing Address - Country:US
Mailing Address - Phone:478-268-9011
Mailing Address - Fax:478-268-9151
Practice Address - Street 1:120 JACKSON ST STE C
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3160
Practice Address - Country:US
Practice Address - Phone:478-268-9011
Practice Address - Fax:478-268-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty