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General NPI Number Information
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NPI Number | 1508242371
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE CHIROPRACTIC
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 1335 JUANITA AVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-1725
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Country | US
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Telephone | 770-535-0550
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Fax | 770-535-1007
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Provider Business Mailing Address
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Address Line | 1335 JUANITA AVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-1725
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Country | US
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Telephone | 770-535-0550
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Fax | 770-535-1007
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JARRED RYAN COLEGROVE
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Credential | D.C.
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Telephone | 770-535-0550
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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 | CHIR007628
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License Number State | GA
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