Provider Demographics
NPI:1760523575
Name:PELHAM CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:PELHAM CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-294-3091
Mailing Address - Street 1:423 BARROW AVE SW
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:GA
Mailing Address - Zip Code:31779-2131
Mailing Address - Country:US
Mailing Address - Phone:229-294-3091
Mailing Address - Fax:229-294-3060
Practice Address - Street 1:423 BARROW AVE SW
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:GA
Practice Address - Zip Code:31779-2131
Practice Address - Country:US
Practice Address - Phone:229-294-3091
Practice Address - Fax:229-294-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU77007Medicare UPIN
GAGRP3500Medicare ID - Type UnspecifiedGROUP NUMBER