Healthcare Provider Details

I. General information

NPI: 1538989587
Provider Name (Legal Business Name): EMPOWER SPORTS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CANTON RD STE B
CUMMING GA
30040-2215
US

IV. Provider business mailing address

1142 OLD ROSWELL RD
ROSWELL GA
30076-1629
US

V. Phone/Fax

Practice location:
  • Phone: 706-994-4618
  • Fax:
Mailing address:
  • Phone: 706-994-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JARED CROSKEY
Title or Position: OWNER
Credential: DC
Phone: 706-994-4618