Healthcare Provider Details

I. General information

NPI: 1225302920
Provider Name (Legal Business Name): ATHENS CHIROPRACTIC HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 N MILLEDGE AVE SUITE A
ATHENS GA
30601-3801
US

IV. Provider business mailing address

623 N MILLEDGE AVE SUITE A
ATHENS GA
30601-3801
US

V. Phone/Fax

Practice location:
  • Phone: 706-227-3292
  • Fax: 888-809-9345
Mailing address:
  • Phone: 706-227-3292
  • Fax: 888-809-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number007566
License Number StateGA

VIII. Authorized Official

Name: JOEL T GROFT
Title or Position: OWNER
Credential: D.C.
Phone: 706-227-3292