Healthcare Provider Details

I. General information

NPI: 1346509635
Provider Name (Legal Business Name): DR ANNA CHIROPRACTOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SWANSON RD
TYRONE GA
30290-6900
US

IV. Provider business mailing address

510 SWANSON RD
TYRONE GA
30290-6900
US

V. Phone/Fax

Practice location:
  • Phone: 770-964-5230
  • Fax: 770-962-8175
Mailing address:
  • Phone: 770-964-5230
  • Fax: 770-962-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007386
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA MOORE JUST BUDY
Title or Position: OWNER
Credential: D.C
Phone: 770-964-5230