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General NPI Number Information
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NPI Number | 1629379599
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Entity Type | Organization
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Legal Business Name | ROYSTON CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 1157 E MAIN ST
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City | ROYSTON
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State | GA
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Zip | 30662-3803
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Country | US
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Telephone | 706-461-2811
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Fax |
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Provider Business Mailing Address
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Address Line | 1157 E MAIN ST
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City | ROYSTON
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State | GA
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Zip | 30662-3803
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Country | US
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Telephone | 706-461-2811
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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. MARCUS HEGGER
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Credential | D.C.
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Telephone | 706-461-2811
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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 | CHIR008603
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License Number State | GA
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