Provider Demographics
NPI:1659714640
Name:HEARTLAND CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:HEARTLAND CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-468-6500
Mailing Address - Street 1:111 W WASHINGTON ST
Mailing Address - Street 2:P.O. BOX 166
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-1239
Mailing Address - Country:US
Mailing Address - Phone:706-468-6500
Mailing Address - Fax:
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1239
Practice Address - Country:US
Practice Address - Phone:706-468-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty