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General NPI Number Information
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NPI Number | 1588094411
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Entity Type | Organization
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Legal Business Name | FULL POTENTIAL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 2410 HOG MOUNTAIN RD 301
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City | WATKINSVILLE
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State | GA
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Zip | 30677-4811
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Country | US
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Telephone | 708-267-4756
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 PENFIELD WAY
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City | GREENSBORO
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State | GA
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Zip | 30642-4821
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Country | US
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Telephone | 708-267-4756
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAZ EBERT
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Credential |
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Telephone | 708-267-4756
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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 |
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License Number State |
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