Provider Demographics
NPI:1295445187
Name:MASON MILL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MASON MILL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-544-9645
Mailing Address - Street 1:1275 MCCONNELL DR STE E
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3505
Mailing Address - Country:US
Mailing Address - Phone:404-321-0082
Mailing Address - Fax:
Practice Address - Street 1:1275 MCCONNELL DR STE E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3505
Practice Address - Country:US
Practice Address - Phone:404-321-0082
Practice Address - Fax:404-321-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty