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General NPI Number Information
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NPI Number | 1780116053
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Entity Type | Organization
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Legal Business Name | GOODHEART CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 280 GLYNN ST S
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2014
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Country | US
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Telephone | 770-460-9272
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Fax | 770-460-9330
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Provider Business Mailing Address
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Address Line | 280 GLYNN ST S
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2014
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Country | US
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Telephone | 770-460-9272
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Fax | 770-460-9330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER GOODHEART
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Credential | DC
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Telephone | 770-460-9272
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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 |
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License Number State | GA
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