Provider Demographics
NPI:1669980256
Name:BUCKHEAD CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:BUCKHEAD CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOWES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-293-4980
Mailing Address - Street 1:3020 MANOR CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1499
Mailing Address - Country:US
Mailing Address - Phone:239-293-4980
Mailing Address - Fax:
Practice Address - Street 1:600 HOUZE WAY STE A1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1432
Practice Address - Country:US
Practice Address - Phone:770-993-9287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009661261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center