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General NPI Number Information
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NPI Number | 1629264072
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Entity Type | Organization
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Legal Business Name | DCLC TWO PC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 131 MECHANIC ST
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City | DAHLONEGA
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State | GA
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Zip | 30533-1337
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Country | US
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Telephone | 706-864-5362
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Fax | 706-864-5761
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Provider Business Mailing Address
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Address Line | PO BOX 599
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City | DAHLONEGA
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State | GA
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Zip | 30533-0010
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Country | US
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Telephone | 706-864-5362
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Fax | 706-864-5761
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Authorized Official
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Title or Position | PROVIDER
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Name | CURTIS FEDORCHUK
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Credential |
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Telephone | 706-864-5362
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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 | 07276
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License Number State | GA
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