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General NPI Number Information
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NPI Number | 1497970024
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Entity Type | Organization
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Legal Business Name | TARA CHIROPRACTIC CARE CENTER, LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 809 FLINT RIVER RD STE 4
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City | JONESBORO
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State | GA
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Zip | 30238-4342
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Country | US
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Telephone | 770-478-6040
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Fax | 770-478-6061
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Provider Business Mailing Address
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Address Line | PO BOX 1378
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-6378
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Country | US
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Telephone | 770-478-6040
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Fax | 770-478-6061
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. CARYN ANN GRZESIAKOWSKI
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Credential | D.C.
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Telephone | 770-478-6040
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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 | CHIR006958
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License Number State | GA
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