Provider Demographics
NPI:1336337450
Name:REGENCY CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:REGENCY CHIROPRACTIC CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-253-9070
Mailing Address - Street 1:49 BRYANT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1490
Mailing Address - Country:US
Mailing Address - Phone:706-253-9070
Mailing Address - Fax:706-253-4356
Practice Address - Street 1:49 BRYANT ST
Practice Address - Street 2:SUITE F
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1490
Practice Address - Country:US
Practice Address - Phone:706-253-9070
Practice Address - Fax:706-253-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJLDMedicare PIN
GAV07322Medicare UPIN