Provider Demographics
NPI:1932760386
Name:MAGNOLIA CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:MAGNOLIA CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VIVIANA
Authorized Official - Last Name:NUNEZ AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-401-7043
Mailing Address - Street 1:1106 FURYS LN STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8219
Mailing Address - Country:US
Mailing Address - Phone:706-869-5565
Mailing Address - Fax:706-869-5572
Practice Address - Street 1:1106 FURYS LN STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-8219
Practice Address - Country:US
Practice Address - Phone:706-869-5565
Practice Address - Fax:706-869-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty