Provider Demographics
NPI:1104269877
Name:ENVISION A CHIROPRACTIC HEALING, LLC
Entity type:Organization
Organization Name:ENVISION A CHIROPRACTIC HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SWANBERG-GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-697-7463
Mailing Address - Street 1:572 MADDOX DR
Mailing Address - Street 2:STE 205
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-4000
Mailing Address - Country:US
Mailing Address - Phone:706-697-7463
Mailing Address - Fax:
Practice Address - Street 1:572 MADDOX DR
Practice Address - Street 2:STE 205
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-4000
Practice Address - Country:US
Practice Address - Phone:706-697-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002792261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR002792OtherSTATE LICENSE
U01224Medicare UPIN
35ZCBFSMedicare Oscar/Certification