Provider Demographics
NPI:1205503760
Name:IWC GEORGIA, INC
Entity type:Organization
Organization Name:IWC GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-913-4904
Mailing Address - Street 1:1815 SILVER OAK DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-4532
Mailing Address - Country:US
Mailing Address - Phone:303-913-4904
Mailing Address - Fax:
Practice Address - Street 1:916 LOGANVILLE HWY STE 1110
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2150
Practice Address - Country:US
Practice Address - Phone:303-913-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty