Provider Demographics
NPI:1538989587
Name:EMPOWER SPORTS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:EMPOWER SPORTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-994-4618
Mailing Address - Street 1:1142 OLD ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1629
Mailing Address - Country:US
Mailing Address - Phone:706-994-4618
Mailing Address - Fax:
Practice Address - Street 1:308 CANTON RD STE B
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2215
Practice Address - Country:US
Practice Address - Phone:706-994-4618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty