Healthcare Provider Details

I. General information

NPI: 1457504367
Provider Name (Legal Business Name): HESS CHIROPRACTIC LIFE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5532 N HENRY BLVD
STOCKBRIDGE GA
30281-3220
US

IV. Provider business mailing address

5532 N HENRY BLVD
STOCKBRIDGE GA
30281-3220
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-4744
  • Fax: 770-979-2275
Mailing address:
  • Phone: 770-389-4744
  • Fax: 770-979-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006576
License Number StateGA

VIII. Authorized Official

Name: JEREMY A HESS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 770-389-4744