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General NPI Number Information
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NPI Number | 1013280619
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Entity Type | Organization
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Legal Business Name | CROSSROADS CHIROPRACTIC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 5391 HIGHWAY 53 SUITE 108
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City | BRASELTON
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State | GA
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Zip | 30517-3135
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Country | US
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Telephone | 706-654-2400
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Fax | 706-654-2399
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Provider Business Mailing Address
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Address Line | 5391 HIGHWAY 53 SUITE 108
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City | BRASELTON
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State | GA
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Zip | 30517-3135
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Country | US
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Telephone | 706-654-2400
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Fax | 706-654-2399
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. RANDY LEE MCSKULIN
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Credential | D.C.
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Telephone | 706-654-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2968
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License Number State | GA
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