Healthcare Provider Details

I. General information

NPI: 1295445187
Provider Name (Legal Business Name): MASON MILL CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 MCCONNELL DR STE E
DECATUR GA
30033-3505
US

IV. Provider business mailing address

1275 MCCONNELL DR STE E
DECATUR GA
30033-3505
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-0082
  • Fax: 404-321-2007
Mailing address:
  • Phone: 404-321-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD COHEN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 321-544-9645