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General NPI Number Information
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NPI Number | 1669980256
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Entity Type | Organization
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Legal Business Name | BUCKHEAD CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 600 HOUZE WAY STE A1
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City | ROSWELL
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State | GA
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Zip | 30076-1432
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Country | US
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Telephone | 770-993-9287
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 MANOR CREEK CT
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City | ROSWELL
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State | GA
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Zip | 30075-1499
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Country | US
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Telephone | 239-293-4980
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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. JILLIAN N. BOWES
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Credential | DO
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Telephone | 239-293-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIR009661
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License Number State | GA
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