Provider Demographics
NPI:1932479052
Name:BETH ANNE FLACK DC PC
Entity Type:Organization
Organization Name:BETH ANNE FLACK DC PC
Other - Org Name:FLACK FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-305-3241
Mailing Address - Street 1:4246 WASHINGTON RD STE 6
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3345
Mailing Address - Country:US
Mailing Address - Phone:706-305-3241
Mailing Address - Fax:706-922-7795
Practice Address - Street 1:4246 WASHINGTON RD STE 6
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3345
Practice Address - Country:US
Practice Address - Phone:706-305-3241
Practice Address - Fax:706-733-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty