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General NPI Number Information
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NPI Number | 1689819468
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Entity Type | Organization
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Legal Business Name | EAST GEORGIA CLINIC OF CHIROPRACTIC
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 403 SHADRACK ST
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City | WAYNESBORO
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State | GA
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Zip | 30830-1540
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Country | US
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Telephone | 706-554-9237
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Fax |
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Provider Business Mailing Address
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Address Line | 403 SHADRACK ST
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City | WAYNESBORO
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State | GA
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Zip | 30830-1540
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Country | US
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Telephone | 706-554-9237
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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. RANDALL CLAYTON LITWILLER
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Credential | D.C.
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Telephone | 93092649802
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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 | CHIR008411
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License Number State | GA
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