Provider Demographics
NPI:1841906963
Name:RUSHING MONGIL, JACK E (DC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:E
Last Name:RUSHING MONGIL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8213
Mailing Address - Country:US
Mailing Address - Phone:706-609-0023
Mailing Address - Fax:
Practice Address - Street 1:715 S THORNTON AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8213
Practice Address - Country:US
Practice Address - Phone:706-609-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor