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General NPI Number Information
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NPI Number | 1861271280
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Entity Type | Organization
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Legal Business Name | COWETA CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 1201 LOWER FAYETTEVILLE RD STE E
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City | NEWNAN
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State | GA
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Zip | 30265-6509
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Country | US
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Telephone | 770-400-8707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 72438
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City | NEWNAN
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State | GA
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Zip | 30271-2438
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Country | US
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Telephone | 770-400-8707
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | JAVIER AMADOR GUTIERREZ
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Credential | DC
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Telephone | 770-400-8707
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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 |
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