Provider Demographics
NPI:1962125161
Name:MINOR CHIROPRACTIC WORKS LLC
Entity type:Organization
Organization Name:MINOR CHIROPRACTIC WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PORSHE
Authorized Official - Middle Name:TIARA
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-603-2623
Mailing Address - Street 1:1050 SHILOH RD NW STE 303
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7197
Mailing Address - Country:US
Mailing Address - Phone:770-370-7588
Mailing Address - Fax:
Practice Address - Street 1:1050 SHILOH RD NW STE 303
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7197
Practice Address - Country:US
Practice Address - Phone:770-370-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1700532884Medicaid