Provider Demographics
NPI:1215158951
Name:FOOTHILLS CHIROPRACTIC
Entity type:Organization
Organization Name:FOOTHILLS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRINCAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-894-4950
Mailing Address - Street 1:924 HIDDEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-5742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 FOOTHILLS PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:MARBLE HILL
Practice Address - State:GA
Practice Address - Zip Code:30148-2261
Practice Address - Country:US
Practice Address - Phone:770-894-4950
Practice Address - Fax:770-894-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13702305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID