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General NPI Number Information
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NPI Number | 1306197892
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE CHIROPRACTIC AND LIFE CENTER
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 5 W FAIN ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4451
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Country | US
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Telephone | 706-946-1215
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Fax | 706-946-1216
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Provider Business Mailing Address
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Address Line | 5 W FAIN ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4451
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Country | US
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Telephone | 706-946-1215
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Fax | 706-946-1216
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON S FUZI
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Credential | D.C.
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Telephone | 706-946-1215
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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 | CHIRO08129
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License Number State | GA
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