Provider Demographics
NPI:1457721730
Name:CHIROCHOICE OF DALTON LLC
Entity Type:Organization
Organization Name:CHIROCHOICE OF DALTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-279-9295
Mailing Address - Street 1:1508 N THORNTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8516
Mailing Address - Country:US
Mailing Address - Phone:706-279-9295
Mailing Address - Fax:706-279-9296
Practice Address - Street 1:1508 N THORNTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8516
Practice Address - Country:US
Practice Address - Phone:706-279-9295
Practice Address - Fax:706-279-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1558423830OtherNPPES