Provider Demographics
NPI:1730483074
Name:UTLEY CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:UTLEY CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TIMONE
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-516-8376
Mailing Address - Street 1:4296 MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1227
Mailing Address - Country:US
Mailing Address - Phone:404-516-8376
Mailing Address - Fax:404-292-2494
Practice Address - Street 1:4296 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1227
Practice Address - Country:US
Practice Address - Phone:404-516-8376
Practice Address - Fax:404-292-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty