Healthcare Provider Details

I. General information

NPI: 1124204607
Provider Name (Legal Business Name): CHESTNUT MOUNTAIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 WINDER HWY
FLOWERY BRANCH GA
30542-3015
US

IV. Provider business mailing address

3703 WINDER HWY
FLOWERY BRANCH GA
30542-3015
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-2220
  • Fax:
Mailing address:
  • Phone: 770-532-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number6952
License Number StateGA

VIII. Authorized Official

Name: JOSEPH MICHAEL HOCK
Title or Position: PRESIDENT
Credential: D.C
Phone: 770-532-2220