Healthcare Provider Details

I. General information

NPI: 1467639435
Provider Name (Legal Business Name): CHIROPRACTIC PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 MOUNT ZION RD
JONESBORO GA
30236
US

IV. Provider business mailing address

2244 MOUNT ZION RD
JONESBORO GA
30236-2528
US

V. Phone/Fax

Practice location:
  • Phone: 678-610-7587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007891
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HYUNG PAK
Title or Position: MANAGER
Credential: D.C.
Phone: 678-610-7587