Provider Demographics
NPI:1538597810
Name:JIMMY CARTER CHIROPRACTIC
Entity type:Organization
Organization Name:JIMMY CARTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC DOCORE
Authorized Official - Prefix:DR
Authorized Official - First Name:SEUNGMO
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-929-3913
Mailing Address - Street 1:5180 JIMMY CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1618
Mailing Address - Country:US
Mailing Address - Phone:678-728-0068
Mailing Address - Fax:678-728-0071
Practice Address - Street 1:5180 JIMMY CARTER BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1618
Practice Address - Country:US
Practice Address - Phone:678-728-0068
Practice Address - Fax:678-728-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13417658302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization