Provider Demographics
NPI:1851578207
Name:HIRAM CHIROPRACTIC
Entity Type:Organization
Organization Name:HIRAM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-222-7555
Mailing Address - Street 1:4484 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:SUITE F 201
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2737
Mailing Address - Country:US
Mailing Address - Phone:770-222-7555
Mailing Address - Fax:770-222-1919
Practice Address - Street 1:4484 JIMMY LEE SMITH PKWY
Practice Address - Street 2:SUITE F 201
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2737
Practice Address - Country:US
Practice Address - Phone:770-222-7555
Practice Address - Fax:770-222-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4984OtherGROUP NUMBER
GA35ZCHFMMedicare PIN