MEDICARE: FOOTHILLS CHIROPRACTIC & HOLISTIC WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1396468849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS CHIROPRACTIC & HOLISTIC WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 818
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-0818
Country	:	US
Telephone Number	:	770-943-6262
Fax Number	:	678-567-5601

Provider Business Practice Location Address
First Line	:	5447 POWDER SPRINGS DALLAS RD SW
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-9103
Country	:	US
Telephone Number	:	770-943-6262
Fax Number	:	678-567-5601

Authorized Official
Title or Position	:	CEO
Name	:	DR. CYNTHIA M LOMAX
Credential	:	DC
Telephone Number	:	770-943-6262

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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