Provider Demographics
NPI:1720485246
Name:CHIRO AT THE CREEK
Entity Type:Organization
Organization Name:CHIRO AT THE CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:HOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-694-1113
Mailing Address - Street 1:11030 BELL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11030 MEDLOCK BRIDGE RD STE 230
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3504
Practice Address - Country:US
Practice Address - Phone:678-694-1113
Practice Address - Fax:678-694-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty