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General NPI Number Information
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NPI Number | 1518149020
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Entity Type | Organization
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Legal Business Name | PHAM CHIROPRACTIC SERVICES, PC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 110 EVANS MILL DR STE 302
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City | DALLAS
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State | GA
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Zip | 30157-1623
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Country | US
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Telephone | 678-363-3334
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Fax | 678-363-3441
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Provider Business Mailing Address
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Address Line | 110 EVANS MILL DR STE 302
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City | DALLAS
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State | GA
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Zip | 30157-1623
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Country | US
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Telephone | 678-363-3334
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Fax | 678-363-3441
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Authorized Official
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Title or Position | INSURANCE BILLING AGENT
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Name | MS. HILDA WONELLE MCCLURE
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Credential |
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Telephone | 770-591-1808
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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 | 006474
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License Number State | GA
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