Provider Demographics
NPI:1255726691
Name:ENVISION CHIROPRACTIC
Entity type:Organization
Organization Name:ENVISION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-276-9609
Mailing Address - Street 1:3903 JILES RD NW
Mailing Address - Street 2:BUILDING 100 SUITE 101
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4612
Mailing Address - Country:US
Mailing Address - Phone:678-276-9609
Mailing Address - Fax:
Practice Address - Street 1:3903 JILES RD NW
Practice Address - Street 2:BUILDING 100 SUITE 101
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4612
Practice Address - Country:US
Practice Address - Phone:678-276-9609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty