Provider Demographics
NPI:1912352394
Name:WISE CRACKS CHIROPRACTIC
Entity Type:Organization
Organization Name:WISE CRACKS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWATEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-664-0502
Mailing Address - Street 1:812 S PARK ST STE 9A
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4412
Mailing Address - Country:US
Mailing Address - Phone:678-664-0502
Mailing Address - Fax:678-348-7691
Practice Address - Street 1:812 S PARK ST STE 9A
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4412
Practice Address - Country:US
Practice Address - Phone:678-664-0502
Practice Address - Fax:678-348-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty