Healthcare Provider Details

I. General information

NPI: 1144304171
Provider Name (Legal Business Name): GENERAL CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 SIXES RD SUITE 120
CANTON GA
30114-8192
US

IV. Provider business mailing address

3760 SIXES RD SUITE 120
CANTON GA
30114-8192
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-4580
  • Fax: 770-704-9142
Mailing address:
  • Phone: 770-704-4580
  • Fax: 770-704-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR005639
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR005505
License Number StateGA

VIII. Authorized Official

Name: DR. EMILY SUE SCHADLER
Title or Position: VICE PRESIDENT
Credential: D.C.
Phone: 770-704-4580