Provider Demographics
NPI:1720696248
Name:EDEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EDEN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-616-6897
Mailing Address - Street 1:1630 BUFORD HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3630
Mailing Address - Country:US
Mailing Address - Phone:770-945-0561
Mailing Address - Fax:
Practice Address - Street 1:1630 BUFORD HWY STE 6
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3630
Practice Address - Country:US
Practice Address - Phone:770-945-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty