Provider Demographics
NPI:1942068648
Name:DRIFTWOOD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DRIFTWOOD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STABBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-456-1990
Mailing Address - Street 1:107 CHARLOTTE DR STE D
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1914
Mailing Address - Country:US
Mailing Address - Phone:912-456-1990
Mailing Address - Fax:912-456-1990
Practice Address - Street 1:107 CHARLOTTE DR STE D
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1914
Practice Address - Country:US
Practice Address - Phone:912-456-1990
Practice Address - Fax:912-456-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty