Provider Demographics
NPI:1184903965
Name:DADE COUNTY CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:DADE COUNTY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CASON
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-657-7597
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0759
Mailing Address - Country:US
Mailing Address - Phone:706-657-7597
Mailing Address - Fax:706-657-7597
Practice Address - Street 1:12605 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2220
Practice Address - Country:US
Practice Address - Phone:706-657-7597
Practice Address - Fax:706-657-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty