Southeastern Chiropractic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR008677 Issued in GA

Legal business name

SOUTHEASTERN CHIROPRACTIC

Practice address

1705 Boulevard SQ
Suite C
Waycross, GA 31501-8031

Phone

(912) 283-3066

Fax

(912) 283-3067

NPI assigned

Dec 15, 2010

Last updated

Dec 15, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly M Gilbert, D.C.NPI 1093027435

Title

Chiropractic/Owner

Phone

(912) 283-3066

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Matthew Gilbert, D.C.

  • Chiropractor
  • Waycross, GA
  • NPI 1093027435
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292371200000",
    "number": "1245533157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 BOULEVARD SQ",
            "address_2": "SUITE C",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315018031",
            "telephone_number": "912-283-3066",
            "fax_number": "912-283-3067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 BOULEVARD SQ",
            "address_2": "SUITE C",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315018031",
            "telephone_number": "912-283-3066",
            "fax_number": "912-283-3067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2010-12-15",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIROPRACTIC/OWNER",
        "authorized_official_telephone_number": "912-283-3066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "1093027435",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southeast Lung & Critical Care Specialists, PC (Southeast Lung Associates)
• Southeast Lung and Critical Care Specialist
• Southern Anesthesia Company, LLC.
• Southern Georgia Regional Commission
• Southern Nurse Anesthesiology, LLC
• Speech Clinic LLC
• Speech-Language Pathology Contractors, Inc.

• Chiropractor in Waycross, GA
• Providers in Waycross, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.