Provider Demographics
NPI:1144304171
Name:GENERAL CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:GENERAL CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SCHADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-704-4580
Mailing Address - Street 1:3760 SIXES RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8192
Mailing Address - Country:US
Mailing Address - Phone:770-704-4580
Mailing Address - Fax:770-704-9142
Practice Address - Street 1:3760 SIXES RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8192
Practice Address - Country:US
Practice Address - Phone:770-704-4580
Practice Address - Fax:770-704-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005639111N00000X
GACHIR005505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5011OtherMEDICARE
GA35ZCHFWMedicare PIN
GAU59728Medicare UPIN
GAGRP5011OtherMEDICARE
GAU66805Medicare UPIN