Provider Demographics
NPI:1952667594
Name:MJA CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MJA CHIROPRACTIC, INC
Other - Org Name:AUTERA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-487-5211
Mailing Address - Street 1:PO BOX 2466
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-0466
Mailing Address - Country:US
Mailing Address - Phone:770-487-5211
Mailing Address - Fax:770-487-5950
Practice Address - Street 1:1952 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4781
Practice Address - Country:US
Practice Address - Phone:770-487-5211
Practice Address - Fax:770-487-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU42024Medicare UPIN
GA35ZCCXRMedicare PIN