Healthcare Provider Details

I. General information

NPI: 1871741439
Provider Name (Legal Business Name): BUCKHEAD CHIROPRACTIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 ROSWELL RD NE STE 140
ATLANTA GA
30305-1836
US

IV. Provider business mailing address

1316 RED HILL RD
MARIETTA GA
30008-5302
US

V. Phone/Fax

Practice location:
  • Phone: 404-455-4804
  • Fax: 404-231-5546
Mailing address:
  • Phone: 404-455-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number008263
License Number StateGA

VIII. Authorized Official

Name: DR. ELTON DARRELL HOLDEN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 404-455-4804