Provider Demographics
NPI:1265737423
Name:PIDCOCK CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:PIDCOCK CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIDCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-798-8980
Mailing Address - Street 1:3028 PEACH ORCHARD RD.
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906
Mailing Address - Country:US
Mailing Address - Phone:706-798-8980
Mailing Address - Fax:706-798-5650
Practice Address - Street 1:3028 PEACH ORCHARD RD.
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-798-8980
Practice Address - Fax:706-798-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDTQMedicare PIN
GAU66800Medicare UPIN