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General NPI Number Information
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NPI Number | 1659260826
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Entity Type | Organization
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Legal Business Name | CSRA MAGNOLIA CHIROPRACTIC & WELLNESS LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1106 FURYS LN STE A
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City | AUGUSTA
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State | GA
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Zip | 30907-8219
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Country | US
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Telephone | 706-869-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 FURYS LN STE A
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City | AUGUSTA
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State | GA
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Zip | 30907-8219
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Country | US
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Telephone | 706-869-5565
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | MARIA VIVIANA NUNEZ AGUILAR
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Credential | D.C.
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Telephone | 706-869-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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