Provider Demographics
NPI:1194952283
Name:TINGLEY FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:TINGLEY FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TINGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-517-2070
Mailing Address - Street 1:2230 TOWNE LAKE PKWY
Mailing Address - Street 2:BLDG. 700 SUITE 120
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5540
Mailing Address - Country:US
Mailing Address - Phone:770-517-2070
Mailing Address - Fax:770-517-0066
Practice Address - Street 1:2230 TOWNE LAKE PKWY
Practice Address - Street 2:BLDG. 700 SUITE 120
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:770-517-2070
Practice Address - Fax:770-517-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty