Organization Name: | PINE MOUNTAIN CHIROPRACTIC CENTER, LLC |
NPI Number: | 1023201217 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIM W. RUSSELL (OFFICE MANAGER) |
Mailing Address: | 624 N Main Ave Pine Mountain |
State: | GA US |
Postal Code: | 318222403 |
Phone Number: | 7066638801 |
Fax Number: | |
NPI Enumeration Date: | 08/22/2007 |
NPI Last Update Date: | 08/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | 2301000RN |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |