Provider Demographics
NPI:1063911360
Name:100 PERCENT CHIROPRACTIC ODOM LLC
Entity type:Organization
Organization Name:100 PERCENT CHIROPRACTIC ODOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-541-6366
Mailing Address - Street 1:15 THOMAS GRACE ANNEX LN
Mailing Address - Street 2:450
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3653
Mailing Address - Country:US
Mailing Address - Phone:912-541-6366
Mailing Address - Fax:
Practice Address - Street 1:15 THOMAS GRACE ANNEX LN
Practice Address - Street 2:450
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3653
Practice Address - Country:US
Practice Address - Phone:912-541-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty