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General NPI Number Information
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NPI Number | 1952458317
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Entity Type | Organization
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Legal Business Name | TUNICA CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 1224 DEFOOR VILLAGE CT NW
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City | ATLANTA
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State | GA
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Zip | 30318-2995
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Country | US
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Telephone | 404-323-8122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19623
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City | ATLANTA
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State | GA
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Zip | 30325-0623
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Country | US
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Telephone | 404-323-8122
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | JEREMY S THOMPSON
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Credential | D.C.
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Telephone | 404-323-8122
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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 | 1185
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1098
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR009141
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License Number State | GA
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