Provider Demographics
NPI:1790100782
Name:CROSSROADS CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-353-7611
Mailing Address - Street 1:320 E. MONTGOMERY CROSSROADS
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-353-7611
Mailing Address - Fax:912-353-7147
Practice Address - Street 1:320 E. MONTGOMERY CROSSROADS
Practice Address - Street 2:SUITE 30
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-353-7611
Practice Address - Fax:912-353-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty