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General NPI Number Information
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NPI Number | 1992975221
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Entity Type | Organization
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Legal Business Name | STILL WATERS FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 200 EAGLES NEST DR BUILDING 300, SUITE A
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City | CANTON
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State | GA
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Zip | 30114-5525
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Country | US
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Telephone | 770-479-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 200 EAGLES NEST DR BUILDING 300, SUITE A
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City | CANTON
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State | GA
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Zip | 30114-5525
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Country | US
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Telephone | 770-479-0655
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DAVID L MARSHALL
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Credential | D.C.
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Telephone | 770-479-0655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIRO08321
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License Number State | GA
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