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General NPI Number Information
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NPI Number | 1376916452
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Entity Type | Organization
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Legal Business Name | CREEKSIDE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 5947 HOLLY SPRINGS PKWY SUITE 308
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City | HOLLY SPRINGS
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State | GA
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Zip | 30188-2447
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Country | US
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Telephone | 770-744-8393
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Fax |
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Provider Business Mailing Address
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Address Line | 5947 HOLLY SPRINGS PKWY SUITE 308
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City | HOLLY SPRINGS
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State | GA
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Zip | 30188-2447
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Country | US
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Telephone | 770-744-8393
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. TRACY IVY JAMES
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Credential | D.C.
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Telephone | 770-744-8393
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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 | CHIR006622
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License Number State | GA
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