Provider Demographics
NPI:1669667887
Name:CARROLL CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CARROLL CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-832-2211
Mailing Address - Street 1:422 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3301
Mailing Address - Country:US
Mailing Address - Phone:770-832-2211
Mailing Address - Fax:770-832-0007
Practice Address - Street 1:422 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3301
Practice Address - Country:US
Practice Address - Phone:770-832-2211
Practice Address - Fax:770-832-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 6524Medicare PIN