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General NPI Number Information
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NPI Number | 1538989587
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Entity Type | Organization
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Legal Business Name | EMPOWER SPORTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 308 CANTON RD STE B
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City | CUMMING
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State | GA
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Zip | 30040-2215
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Country | US
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Telephone | 706-994-4618
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 OLD ROSWELL RD
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City | ROSWELL
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State | GA
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Zip | 30076-1629
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Country | US
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Telephone | 706-994-4618
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED CROSKEY
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Credential | DC
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Telephone | 706-994-4618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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