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General NPI Number Information
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NPI Number | 1780701367
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC SERVICES TRUST
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7990 KNOX BRIDGE HWY
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City | CANTON
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State | GA
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Zip | 30114-8520
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Country | US
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Telephone | 770-479-5592
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Fax | 770-479-5594
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Provider Business Mailing Address
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Address Line | 7990 KNOX BRIDGE HWY
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City | CANTON
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State | GA
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Zip | 30114-8520
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Country | US
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Telephone | 770-479-5592
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Fax | 770-479-5594
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LOUIS R. BRIEGEL II
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Credential | DC
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Telephone | 770-479-5592
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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 | CHIR001652
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License Number State | GA
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