Provider Demographics
NPI:1710158407
Name:MATTHEW DAVIS CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:MATTHEW DAVIS CHIROPRACTIC CENTER INC.
Other - Org Name:DBA CROSSROADS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-252-1848
Mailing Address - Street 1:3339 HIGHWAY 34 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3564
Mailing Address - Country:US
Mailing Address - Phone:770-252-1848
Mailing Address - Fax:770-252-1807
Practice Address - Street 1:3339 HIGHWAY 34 E
Practice Address - Street 2:SUITE C
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3564
Practice Address - Country:US
Practice Address - Phone:770-252-1848
Practice Address - Fax:770-252-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU94985Medicare UPIN