=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265558159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GADSDEN CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6063 PEACHTREE PKWY SUITE 103B
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-246-0340
-----------------------------------------------------
Fax | 770-246-1735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6063 PEACHTREE PARKWAY SUITE 103B
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-246-0340
-----------------------------------------------------
Fax | 770-246-1735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BYRON COURTNEY GADSDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-246-0340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 006241
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------