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General NPI Number Information
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NPI Number | 1891098158
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Entity Type | Organization
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Legal Business Name | GEORGIA SPECIFIC CLINIC OF CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 49 PIEDMONT DR SUITE 104
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City | WINDER
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State | GA
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Zip | 30680-8118
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Country | US
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Telephone | 770-896-0157
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1665
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City | WINDER
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State | GA
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Zip | 30680-6665
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM EDGARDO SORIANO
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Credential | D.C.
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Telephone | 770-896-0157
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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 | CHIR008754
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License Number State | GA
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