Provider Demographics
NPI:1336219609
Name:MAX D PROCTOR CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:MAX D PROCTOR CHIROPRACTIC CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:DOYAL
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:706-629-7340
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:510 WEST BELMONT MAX D PROCTOR DC
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-629-7340
Mailing Address - Fax:706-629-7340
Practice Address - Street 1:510 WEST BELMONT
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30703
Practice Address - Country:US
Practice Address - Phone:706-629-7340
Practice Address - Fax:706-629-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty