Organization
CREEKSIDE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY IVY JAMES D.C. (PARTNER)
(770) 744-8393
Entity
Organization
Contact information
Practice address
5947 HOLLY SPRINGS PKWY, SUITE 308, HOLLY SPRINGS, GA 30188-2447
(770) 744-8393
Mailing address
5947 HOLLY SPRINGS PKWY, SUITE 308, HOLLY SPRINGS, GA 30188-2447
(770) 744-8393
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR006622
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I354499
MEDICARE PTAN
GA
01
—
202I358649
MEDICARE
GA
Enumeration date
11/11/2015
Last updated
11/11/2015
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