Provider Demographics
NPI:1821354739
Name:YAKES CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:YAKES CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:YAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:777-426-4848
Mailing Address - Street 1:3900 LEGACY PARK BLVD NW STE C200
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7416
Mailing Address - Country:US
Mailing Address - Phone:770-426-4848
Mailing Address - Fax:770-426-1139
Practice Address - Street 1:3900 LEGACY PARK BLVD NW STE C200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7416
Practice Address - Country:US
Practice Address - Phone:770-426-4848
Practice Address - Fax:770-426-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty