Provider Demographics
NPI:1780701367
Name:CHIROPRACTIC SERVICES TRUST
Entity type:Organization
Organization Name:CHIROPRACTIC SERVICES TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRIEGEL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:770-479-5592
Mailing Address - Street 1:7990 KNOX BRIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8520
Mailing Address - Country:US
Mailing Address - Phone:770-479-5592
Mailing Address - Fax:770-479-5594
Practice Address - Street 1:7990 KNOX BRIDGE HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8520
Practice Address - Country:US
Practice Address - Phone:770-479-5592
Practice Address - Fax:770-479-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHPKMedicare ID - Type UnspecifiedNUMBER
GA35ZCHPJMedicare ID - Type UnspecifiedNUMBER
GAGRP6356Medicare ID - Type UnspecifiedGROUP NUMBER
GAT97510Medicare UPIN
GAT97511Medicare UPIN