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General NPI Number Information
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NPI Number | 1770974602
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Entity Type | Organization
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Legal Business Name | TOWN AND COUNTRY CHIROPRACTIC
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 255 N MAIN ST STE C
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City | MADISON
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State | GA
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Zip | 30650-1390
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Country | US
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Telephone | 706-438-1314
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Fax | 706-438-1315
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Provider Business Mailing Address
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Address Line | 255 N MAIN ST
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City | MADISON
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State | GA
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Zip | 30650-1390
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Country | US
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Telephone | 706-438-1314
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Fax | 706-438-1315
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | VANESSA N PIZZA
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Credential | D.C.
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Telephone | 706-438-1314
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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 | CHIR009323
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License Number State | GA
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