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General NPI Number Information
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NPI Number | 1699938514
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Entity Type | Organization
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Legal Business Name | STUCKEY CLINIC OF CHIROPRACTIC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 2557 HIGHWAY 76
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City | CHATSWORTH
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State | GA
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Zip | 30705-7311
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Country | US
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Telephone | 706-517-0419
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Fax | 706-517-0420
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Provider Business Mailing Address
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Address Line | 2557 HIGHWAY 76
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City | CHATSWORTH
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State | GA
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Zip | 30705-7311
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Country | US
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Telephone | 706-517-0419
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Fax | 706-517-0420
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Authorized Official
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Title or Position | DOCTOR/CEO
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Name | DR. ORVILLE L STUCKEY JR.
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Credential | D.C.
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Telephone | 706-517-0419
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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 | CHIR007582
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License Number State | GA
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