Provider Demographics
NPI:1902097520
Name:AMERICUS INJURY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:AMERICUS INJURY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:FAULK
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-928-0424
Mailing Address - Street 1:1526 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4554
Mailing Address - Country:US
Mailing Address - Phone:229-928-0424
Mailing Address - Fax:229-928-0250
Practice Address - Street 1:1526 ELM AVE
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4554
Practice Address - Country:US
Practice Address - Phone:229-928-0424
Practice Address - Fax:229-928-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty