Provider Demographics
NPI:1265912604
Name:FEIDY CHIROPRACTIC CLINIC INC, DBA CARDWELL CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:FEIDY CHIROPRACTIC CLINIC INC, DBA CARDWELL CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SINAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:FEIDY
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS, DC
Authorized Official - Phone:404-805-6366
Mailing Address - Street 1:1230 JOHNSON FERRY PL STE G30
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2058
Mailing Address - Country:US
Mailing Address - Phone:770-977-9200
Mailing Address - Fax:770-977-5531
Practice Address - Street 1:1230 JOHNSON FERRY PL STE G30
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-977-9200
Practice Address - Fax:770-977-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1841703188Medicaid