Provider Demographics
NPI:1871741439
Name:BUCKHEAD CHIROPRACTIC GROUP
Entity type:Organization
Organization Name:BUCKHEAD CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-455-4804
Mailing Address - Street 1:1316 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-5302
Mailing Address - Country:US
Mailing Address - Phone:404-455-4804
Mailing Address - Fax:
Practice Address - Street 1:3155 ROSWELL RD NE STE 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1836
Practice Address - Country:US
Practice Address - Phone:404-455-4804
Practice Address - Fax:404-231-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty