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General NPI Number Information
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NPI Number | 1326463993
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC CENTER P.C.
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 408 US HIGHWAY 80 SW
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City | POOLER
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State | GA
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Zip | 31322-2541
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Country | US
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Telephone | 912-748-0350
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Fax | 912-450-0350
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Provider Business Mailing Address
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Address Line | 408 US HIGHWAY 80 SW
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City | POOLER
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State | GA
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Zip | 31322-2541
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Country | US
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Telephone | 912-748-0350
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Fax | 912-450-0350
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Authorized Official
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Title or Position | PRESIDENT
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Name | PRESTON PEACOCK
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Credential | DC
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Telephone | 912-748-0350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 006632
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License Number State | GA
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