Provider Demographics
NPI:1699195156
Name:WETHERINGTON CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:WETHERINGTON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BART
Authorized Official - Last Name:WETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-351-0005
Mailing Address - Street 1:5602 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6296
Mailing Address - Country:US
Mailing Address - Phone:912-351-0005
Mailing Address - Fax:912-351-0007
Practice Address - Street 1:329 EISENHOWER DR STE D
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2695
Practice Address - Country:US
Practice Address - Phone:912-351-0005
Practice Address - Fax:912-351-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGPDOtherMEDICARE PTAN
GA35ZCGPDOtherMEDICARE PTAN