Provider Demographics
NPI:1659613867
Name:FOUNDATION CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FOUNDATION CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-546-1616
Mailing Address - Street 1:1060 GAINES SCHOOL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3198
Mailing Address - Country:US
Mailing Address - Phone:706-546-1616
Mailing Address - Fax:866-667-9978
Practice Address - Street 1:1060 GAINES SCHOOL RD
Practice Address - Street 2:SUITE C
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3198
Practice Address - Country:US
Practice Address - Phone:706-546-1616
Practice Address - Fax:866-667-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDPBMedicare UPIN