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General NPI Number Information
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NPI Number | 1669895678
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Entity Type | Organization
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Legal Business Name | RIVER OF LIFE CHIROPRACTIC, INC
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 1071 ATHENS RD
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City | CRAWFORD
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State | GA
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Zip | 30630-2529
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Country | US
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Telephone | 706-743-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 1071 ATHENS RD
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City | CRAWFORD
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State | GA
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Zip | 30630-2529
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Country | US
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Telephone | 706-743-3757
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Fax | 877-481-8644
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Authorized Official
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Title or Position | DR/CEO
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Name | RHONDA RAE MILLS
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Credential | DC
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Telephone | 706-743-3757
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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 | CHIRO08449
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License Number State | GA
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