Provider Demographics
NPI:1770072407
Name:CHIROCARE REHABILITATION
Entity type:Organization
Organization Name:CHIROCARE REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-289-8855
Mailing Address - Street 1:9374 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-6022
Mailing Address - Country:US
Mailing Address - Phone:678-289-8855
Mailing Address - Fax:678-952-8134
Practice Address - Street 1:9374 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-6022
Practice Address - Country:US
Practice Address - Phone:678-289-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009201111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty