Organization
PINE MOUNTAIN CHIROPRACTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM W. RUSSELL MANAGING MEMBER (OFFICE MANAGER)
(706) 663-8801
Entity
Organization
Contact information
Practice address
624 N MAIN AVE, PINE MOUNTAIN, GA 31822-2403
(706) 663-8801
Mailing address
624 N MAIN AVE, P.O. BOX 1690, PINE MOUNTAIN, GA 31822-2403
(706) 663-8801
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
2301000RN
GA
Other
Enumeration date
08/22/2007
Last updated
08/22/2007
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