Provider Demographics
NPI:1679612741
Name:CHASTAIN CHIROPRACTIC OFFICE, P.C.
Entity type:Organization
Organization Name:CHASTAIN CHIROPRACTIC OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-353-7778
Mailing Address - Street 1:PO BOX 5552
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-5552
Mailing Address - Country:US
Mailing Address - Phone:706-353-7778
Mailing Address - Fax:706-369-8881
Practice Address - Street 1:455 N MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-3807
Practice Address - Country:US
Practice Address - Phone:706-353-7778
Practice Address - Fax:706-369-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA995, 8125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty