Provider Demographics
NPI:1881849305
Name:BULLOCH CHIROPRACTIC
Entity Type:Organization
Organization Name:BULLOCH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-489-2888
Mailing Address - Street 1:125 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5387
Mailing Address - Country:US
Mailing Address - Phone:912-489-2888
Mailing Address - Fax:912-489-2888
Practice Address - Street 1:125 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5387
Practice Address - Country:US
Practice Address - Phone:912-489-2888
Practice Address - Fax:912-489-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty