Healthcare Provider Details

I. General information

NPI: 1952541468
Provider Name (Legal Business Name): TRI-COUNTY CLINIC OF CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 CHURCH ST
VIDALIA GA
30474-4738
US

IV. Provider business mailing address

511 CHURCH ST
VIDALIA GA
30474-4738
US

V. Phone/Fax

Practice location:
  • Phone: 912-538-0508
  • Fax:
Mailing address:
  • Phone: 912-538-0708
  • Fax: 912-538-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIRO08437
License Number StateGA

VIII. Authorized Official

Name: HEIDI MARIE REUSCHLING
Title or Position: OWNER
Credential: DC
Phone: 912-538-0708