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General NPI Number Information
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NPI Number | 1699077701
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Entity Type | Organization
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Legal Business Name | TRULIFE CHIROPRACTIC AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 126 N. PIEDMONT AVE
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City | ROCKMART
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State | GA
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Zip | 30153
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Country | US
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Telephone | 678-685-4483
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Fax | 678-685-4487
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Provider Business Mailing Address
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Address Line | 126 N. PIEDMONT AVE
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City | ROCKMART
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State | GA
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Zip | 30153
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Country | US
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Telephone | 678-685-4483
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Fax | 678-685-4487
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMANDA JEAN GILES
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Credential | DC
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Telephone | 678-685-4483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CHIR008743
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License Number State | GA
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