Provider Demographics
NPI:1285926006
Name:NEIGHBORHOOD CHIROPRACTIC & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:NEIGHBORHOOD CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:MAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-942-3818
Mailing Address - Street 1:328 SILVERTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7420
Mailing Address - Country:US
Mailing Address - Phone:770-942-3818
Mailing Address - Fax:678-840-9461
Practice Address - Street 1:514 W BANKHEAD HWY STE 300
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1737
Practice Address - Country:US
Practice Address - Phone:770-617-7434
Practice Address - Fax:678-840-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty