Provider Demographics
NPI:1689331498
Name:MUSTARD SEED CHIROPRACTIC
Entity Type:Organization
Organization Name:MUSTARD SEED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGERRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT-BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-756-7741
Mailing Address - Street 1:3115 ROSWELL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7611
Mailing Address - Country:US
Mailing Address - Phone:770-756-7741
Mailing Address - Fax:
Practice Address - Street 1:1060 WINDY HILL RD SE STE 209
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2065
Practice Address - Country:US
Practice Address - Phone:770-756-7741
Practice Address - Fax:678-403-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty