Healthcare Provider Details

I. General information

NPI: 1184197618
Provider Name (Legal Business Name): STRACK CHIROPRACTIC WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 CREEKSTONE RDG
WOODSTOCK GA
30188-3732
US

IV. Provider business mailing address

246 CREEKSTONE RDG
WOODSTOCK GA
30188-3732
US

V. Phone/Fax

Practice location:
  • Phone: 678-494-9668
  • Fax:
Mailing address:
  • Phone: 678-494-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH CHARLES STRACK
Title or Position: OWNER
Credential: DC
Phone: 678-480-6075