Provider Demographics
NPI:1659564441
Name:MDR, INC.
Entity Type:Organization
Organization Name:MDR, INC.
Other - Org Name:OAK ROAD FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-979-3701
Mailing Address - Street 1:1001 OAK RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1891
Mailing Address - Country:US
Mailing Address - Phone:770-979-3701
Mailing Address - Fax:770-979-3702
Practice Address - Street 1:1001 OAK RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1891
Practice Address - Country:US
Practice Address - Phone:770-979-3701
Practice Address - Fax:770-979-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHTHMedicare PIN
GAU90842Medicare UPIN