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General NPI Number Information
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NPI Number | 1538370341
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Entity Type | Organization
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Legal Business Name | GLAME CHIROPRACTIC, INC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 5532 N HENRY BLVD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3220
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Country | US
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Telephone | 770-389-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 5430 N HENRY BLVD SUITE 100
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMANDA HESS
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Credential | D.C.
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Telephone | 770-389-4744
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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 | 007470
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License Number State | GA
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