Provider Demographics
NPI:1669646725
Name:EMANUEL COUNTY CLINIC OF CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EMANUEL COUNTY CLINIC OF CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-237-7246
Mailing Address - Street 1:120 JACKSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3157
Mailing Address - Country:US
Mailing Address - Phone:478-237-7246
Mailing Address - Fax:478-237-7248
Practice Address - Street 1:120 JACKSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3157
Practice Address - Country:US
Practice Address - Phone:478-237-7246
Practice Address - Fax:478-237-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty