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General NPI Number Information
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NPI Number | 1073861316
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Entity Type | Organization
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Legal Business Name | FAMILY LIFE CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 583 HIGHLAND CROSSING SUITE #240
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-1861
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Country | US
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Telephone | 706-276-1099
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Fax | 706-276-1045
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | EAST ELLIJAY
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State | GA
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Zip | 30539-0014
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Country | US
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Telephone | 706-276-1099
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Fax | 706-276-1045
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | STACEY DAWN DAVIS
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Credential | D.C.
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Telephone | 706-276-1099
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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 |
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License Number State |
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