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General NPI Number Information
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NPI Number | 1285926006
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD CHIROPRACTIC & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 514 W BANKHEAD HWY STE 300
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City | VILLA RICA
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State | GA
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Zip | 30180-1737
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Country | US
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Telephone | 770-617-7434
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Fax | 678-840-9461
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Provider Business Mailing Address
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Address Line | 328 SILVERTHORNE CIR
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-7420
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Country | US
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Telephone | 770-942-3818
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Fax | 678-840-9461
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE TAYLOR MAHLE
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Credential | D.C.
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Telephone | 770-942-3818
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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 | 6322
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License Number State | GA
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