Provider Demographics
NPI:1821708314
Name:RESTORE CHIROPRACTIC
Entity Type:Organization
Organization Name:RESTORE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-766-0089
Mailing Address - Street 1:187 ROCK CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7305
Mailing Address - Country:US
Mailing Address - Phone:706-766-0089
Mailing Address - Fax:
Practice Address - Street 1:105 JW PLAZA DR SE STE 5
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1503
Practice Address - Country:US
Practice Address - Phone:762-204-2138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty