Organization
SOUTHEASTERN CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY M GILBERT D.C. (CHIROPRACTIC/OWNER)
(912) 283-3066
Entity
Organization
Contact information
Practice address
1705 BOULEVARD SQ, SUITE C, WAYCROSS, GA 31501-8031
(912) 283-3066
(912) 283-3067
Mailing address
1705 BOULEVARD SQ, SUITE C, WAYCROSS, GA 31501-8031
(912) 283-3066
(912) 283-3067
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR008677
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093027435
TAX ID
GA
Enumeration date
12/15/2010
Last updated
12/15/2010
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