Provider Demographics
NPI:1134807928
Name:WADE FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:WADE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL'LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-797-0092
Mailing Address - Street 1:140 HOWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2095
Mailing Address - Country:US
Mailing Address - Phone:770-740-5000
Mailing Address - Fax:770-740-5000
Practice Address - Street 1:140 HOWELL RD STE D
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2095
Practice Address - Country:US
Practice Address - Phone:770-740-5000
Practice Address - Fax:770-740-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty