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General NPI Number Information
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NPI Number | 1164889291
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Entity Type | Organization
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Legal Business Name | CENTRAL GEORGIA CLINIC OF CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 120 JACKSON ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3157
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Country | US
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Telephone | 478-268-9011
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Fax |
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Provider Business Mailing Address
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Address Line | 120 JACKSON ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3157
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Country | US
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Telephone | 478-268-9011
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN GALLAGHER
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Credential | D.C.
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Telephone | 843-539-1111
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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 | CHIR009617
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR009595
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License Number State | GA
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