Provider Demographics
NPI:1710096870
Name:MCCRACKEN, CHRISTOPHER BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 S WALL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-3066
Mailing Address - Country:US
Mailing Address - Phone:706-624-0200
Mailing Address - Fax:706-624-9136
Practice Address - Street 1:1012 S WALL ST
Practice Address - Street 2:SUITE A
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3066
Practice Address - Country:US
Practice Address - Phone:706-624-0200
Practice Address - Fax:706-624-9136
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA352CDHQMedicare ID - Type Unspecified