Provider Demographics
NPI:1518014877
Name:MUDBONE PRODUCTIONS INC
Entity type:Organization
Organization Name:MUDBONE PRODUCTIONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CADICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-423-1799
Mailing Address - Street 1:3567 CHEROKEE ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1966
Mailing Address - Country:US
Mailing Address - Phone:770-423-1799
Mailing Address - Fax:
Practice Address - Street 1:3567 CHEROKEE ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1966
Practice Address - Country:US
Practice Address - Phone:770-423-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty