Provider Demographics
NPI:1902012396
Name:ADAIRSVILLE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ADAIRSVILLE CHIROPRACTIC CENTER
Other - Org Name:CALHOUN SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKELEY
Authorized Official - Middle Name:REID
Authorized Official - Last Name:DERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-629-4999
Mailing Address - Street 1:127 WC BRYANT PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2654
Mailing Address - Country:US
Mailing Address - Phone:706-629-4999
Mailing Address - Fax:706-629-4799
Practice Address - Street 1:127 WC BRYANT PKWY
Practice Address - Street 2:STE A
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2654
Practice Address - Country:US
Practice Address - Phone:706-629-4999
Practice Address - Fax:706-629-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU93851Medicare UPIN
GA35-ZCHCXMedicare ID - Type Unspecified