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General NPI Number Information
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NPI Number | 1952678138
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CLINIC OF SNELLVILLE, INC.
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 2331 HENRY CLOWER BLVD STE C
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City | SNELLVILLE
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State | GA
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Zip | 30078-3158
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Country | US
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Telephone | 770-982-5155
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Fax | 770-982-4262
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Provider Business Mailing Address
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Address Line | 2331 HENRY CLOWER BLVD STE C
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City | SNELLVILLE
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State | GA
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Zip | 30078-3158
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Country | US
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Telephone | 770-982-5155
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Fax | 770-982-4262
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN WILLIAM SIERADZKI
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Credential | D.C.
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Telephone | 770-982-5155
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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 | CHIR002081
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License Number State | GA
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