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General NPI Number Information
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NPI Number | 1639371917
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Entity Type | Organization
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Legal Business Name | GIDEON CHIROPRACTIC INCORPORATED
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 165 BURKE ST SUITE 105
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 770-389-4724
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Fax | 678-272-4031
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Provider Business Mailing Address
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Address Line | 165 BURKE ST SUITE 105
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3463
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Country | US
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Telephone | 770-389-4724
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Fax | 678-272-4031
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Authorized Official
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Title or Position | OWNER
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Name | DR. DURIE DELANO HUMBER JR.
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Credential |
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Telephone | 770-389-4724
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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 | CHIR005325
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License Number State | GA
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