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General NPI Number Information
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NPI Number | 1770072407
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Entity Type | Organization
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Legal Business Name | CHIROCARE REHABILITATION
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 9374 S MAIN ST
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City | JONESBORO
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State | GA
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Zip | 30236-6022
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Country | US
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Telephone | 678-289-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 9374 S MAIN ST
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City | JONESBORO
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State | GA
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Zip | 30236-6022
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Country | US
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Telephone | 678-289-8855
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Fax | 678-952-8134
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CANDACE PRAYOR
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Credential |
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Telephone | 678-289-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 009201
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License Number State | GA
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