Provider Demographics
NPI:1144481458
Name:NEW HOPE CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:NEW HOPE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-719-2221
Mailing Address - Street 1:740 GLYNN ST N STE E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6707
Mailing Address - Country:US
Mailing Address - Phone:770-719-2221
Mailing Address - Fax:770-719-2210
Practice Address - Street 1:740 GLYNN ST N STE E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-6707
Practice Address - Country:US
Practice Address - Phone:770-719-2221
Practice Address - Fax:770-719-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008288305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization