Provider Demographics
NPI:1659444545
Name:SOUTH GEORGIA CLINIC OF CHIROPRACTIC MEDICINE
Entity Type:Organization
Organization Name:SOUTH GEORGIA CLINIC OF CHIROPRACTIC MEDICINE
Other - Org Name:SIRCY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SIRCY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:229-985-1370
Mailing Address - Street 1:720 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5450
Mailing Address - Country:US
Mailing Address - Phone:229-985-1370
Mailing Address - Fax:
Practice Address - Street 1:720 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5450
Practice Address - Country:US
Practice Address - Phone:229-985-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52671605OtherBCBS
GA55003710AMedicaid
GA52671605OtherBCBS