Provider Demographics
NPI:1245454412
Name:OSTROW FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:OSTROW FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:DARRYL
Authorized Official - Last Name:OSTROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-445-6919
Mailing Address - Street 1:500 NATHAN DEAN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157
Mailing Address - Country:US
Mailing Address - Phone:770-445-6919
Mailing Address - Fax:770-445-5659
Practice Address - Street 1:500 NATHAN DEAN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157
Practice Address - Country:US
Practice Address - Phone:770-445-6919
Practice Address - Fax:770-445-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69557Medicare UPIN
GA35ZCFDHMedicare ID - Type Unspecified