Provider Demographics
NPI:1891098158
Name:GEORGIA SPECIFIC CLINIC OF CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GEORGIA SPECIFIC CLINIC OF CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-896-0157
Mailing Address - Street 1:PO BOX 1665
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 PIEDMONT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8118
Practice Address - Country:US
Practice Address - Phone:770-896-0157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty