Provider Demographics
NPI:1013508456
Name:PAIN AND ACCIDENT CHIROPRACTIC-WOODSTOCK LLC
Entity Type:Organization
Organization Name:PAIN AND ACCIDENT CHIROPRACTIC-WOODSTOCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-403-5689
Mailing Address - Street 1:5665 ATLANTA HWY STE 103-137
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3959
Mailing Address - Country:US
Mailing Address - Phone:404-403-5689
Mailing Address - Fax:
Practice Address - Street 1:12035 HIGHWAY 92 STE 400
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7010
Practice Address - Country:US
Practice Address - Phone:678-445-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty