Provider Demographics
NPI:1336339076
Name:SUMMERVILLE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SUMMERVILLE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:M
Authorized Official - Last Name:APPELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-857-4911
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:74 HIGHWAY 48
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-0424
Mailing Address - Country:US
Mailing Address - Phone:706-857-4911
Mailing Address - Fax:706-857-6560
Practice Address - Street 1:74 HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-0424
Practice Address - Country:US
Practice Address - Phone:706-857-4911
Practice Address - Fax:706-857-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA5840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6417Medicare PIN