Provider Demographics
NPI:1891895009
Name:ADVANCED CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:AYERS
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-636-6500
Mailing Address - Street 1:2738 CLAIRMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2713
Mailing Address - Country:US
Mailing Address - Phone:404-636-6500
Mailing Address - Fax:404-636-6072
Practice Address - Street 1:2738 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2713
Practice Address - Country:US
Practice Address - Phone:404-636-6500
Practice Address - Fax:404-636-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001561261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU41783Medicare UPIN
GAGRP2388Medicare ID - Type Unspecified