Provider Demographics
NPI: | 1790949048 |
---|---|
Name: | TUTEN CHIROPRACTIC CENTER, PC |
Entity Type: | Organization |
Organization Name: | TUTEN CHIROPRACTIC CENTER, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SARAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DODSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 229-246-6417 |
Mailing Address - Street 1: | PO BOX 933 |
Mailing Address - Street 2: | |
Mailing Address - City: | BAINBRIDGE |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 39818-0933 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 229-246-6417 |
Mailing Address - Fax: | 229-246-2041 |
Practice Address - Street 1: | 406 S WEST ST |
Practice Address - Street 2: | |
Practice Address - City: | BAINBRIDGE |
Practice Address - State: | GA |
Practice Address - Zip Code: | 39819-3918 |
Practice Address - Country: | US |
Practice Address - Phone: | 229-246-6417 |
Practice Address - Fax: | 229-246-2041 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-07-16 |
Last Update Date: | 2008-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | CHIR006256 | 261QM2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |