Provider Demographics
NPI:1285681890
Name:WINDWARD CHIROPRACTIC & WELLNESS, INC
Entity type:Organization
Organization Name:WINDWARD CHIROPRACTIC & WELLNESS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES./DIRECTOR OF OFFICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-319-9777
Mailing Address - Street 1:210 PROSPECT PL
Mailing Address - Street 2:GEORGETOWNE PARK
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5454
Mailing Address - Country:US
Mailing Address - Phone:678-319-9777
Mailing Address - Fax:678-319-9966
Practice Address - Street 1:210 PROSPECT PL
Practice Address - Street 2:GEORGETOWNE PARK
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5454
Practice Address - Country:US
Practice Address - Phone:678-319-9777
Practice Address - Fax:678-319-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHMKMedicare PIN
GAT71252Medicare UPIN