Provider Demographics
NPI:1235398652
Name:DAHLONEGA CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:DAHLONEGA CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-867-0974
Mailing Address - Street 1:89 LONG BRANCH RD
Mailing Address - Street 2:A6
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 LONG BRANCH RD
Practice Address - Street 2:A6
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-9305
Practice Address - Country:US
Practice Address - Phone:706-867-0974
Practice Address - Fax:706-867-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty