Provider Demographics
NPI:1912124348
Name:DACULA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DACULA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:UHRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-822-1922
Mailing Address - Street 1:1858 AUTUMN SAGE DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7280
Mailing Address - Country:US
Mailing Address - Phone:770-614-0407
Mailing Address - Fax:
Practice Address - Street 1:465 DACULA RD
Practice Address - Street 2:SUITE I
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2170
Practice Address - Country:US
Practice Address - Phone:770-822-1922
Practice Address - Fax:770-822-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU67427Medicare UPIN
GAGRP5054Medicare ID - Type Unspecified