Provider Demographics
NPI:1972822377
Name:VALDOSTA CHIROPRACTIC & REHAB, LLC
Entity type:Organization
Organization Name:VALDOSTA CHIROPRACTIC & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LACIE
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-247-2828
Mailing Address - Street 1:PO BOX 5192
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-5192
Mailing Address - Country:US
Mailing Address - Phone:229-247-2828
Mailing Address - Fax:
Practice Address - Street 1:701 BAYTREE RD
Practice Address - Street 2:SUITE D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2880
Practice Address - Country:US
Practice Address - Phone:229-247-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty