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General NPI Number Information
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NPI Number | 1598209090
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Entity Type | Organization
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Legal Business Name | DOUGLAS FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 105 SHIRLEY AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-2325
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Country | US
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Telephone | 912-384-4494
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Fax | 912-383-3381
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Provider Business Mailing Address
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Address Line | 105 SHIRLEY AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-2325
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Country | US
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Telephone | 912-384-4494
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Fax | 912-383-3381
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN ADAM LOREN SR.
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Credential | DC
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Telephone | 912-384-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIRO009727
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License Number State | GA
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