Healthcare Provider Details

I. General information

NPI: 1104269877
Provider Name (Legal Business Name): ENVISION A CHIROPRACTIC HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 MADDOX DR STE 205
EAST ELLIJAY GA
30540-4000
US

IV. Provider business mailing address

572 MADDOX DR STE 205
EAST ELLIJAY GA
30540-4000
US

V. Phone/Fax

Practice location:
  • Phone: 706-697-7463
  • Fax:
Mailing address:
  • Phone: 706-697-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberCHIR002792
License Number StateGA

VIII. Authorized Official

Name: DR. DEBRAH K SWANBERG-GROSSMAN
Title or Position: OWNER/DIRECTOR
Credential: DC
Phone: 706-697-7463