Provider Demographics
NPI:1386774529
Name:CHIROWISE, INC.
Entity type:Organization
Organization Name:CHIROWISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-506-4344
Mailing Address - Street 1:102 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5049
Mailing Address - Country:US
Mailing Address - Phone:770-506-4344
Mailing Address - Fax:770-506-9414
Practice Address - Street 1:102 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5049
Practice Address - Country:US
Practice Address - Phone:770-506-4344
Practice Address - Fax:770-506-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6427Medicare ID - Type UnspecifiedGROUP NUMBER