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General NPI Number Information
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NPI Number | 1780166215
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Entity Type | Organization
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Legal Business Name | JOURNEY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 4946 BILL GARDNER PARKWAY
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City | LOCUST GROVE
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State | GA
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Zip | 30248-6835
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Country | US
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Telephone | 706-400-6750
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Fax |
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Provider Business Mailing Address
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Address Line | 308 RACETRACK RD
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City | MCDONOUGH
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State | GA
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Zip | 30252-6835
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Country | US
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Telephone | 706-400-6750
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSETT MCLEMORE
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Credential | DC
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Telephone | 706-400-6750
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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 | CHIR009914
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License Number State | GA
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