NPIMap

Organization Active NPI

Thacker Chiropractic Clinic, LLC

  • Chiropractor
  • Conyers, GA
National Provider Identifier
1255489712
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR002342 Issued in GA
Legal business name
THACKER CHIROPRACTIC CLINIC, LLC
Practice address
1815 Highway 138 SE
Suite 600
Conyers, GA 30013-2079
Phone
(770) 860-8333
Fax
(770) 860-8833
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

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

Authorized official

Name
Dr. Mitchel L. Thacker, D.CNPI 1710059498
Title
Co-Owner
Phone
(770) 860-8333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIR002342 GA Primary

Addresses

Primary practice location

1815 Highway 138 SE
Suite 600
Conyers, GA 30013-2079

Mailing address

1815 Highway 138 SE
Suite 600
Conyers, GA 30013-2079
Phone (770) 860-8333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040528000454 GA Part B Supplier - Clinic/Group Practice 9739160300 Receives reassigned benefits from 2 practitioners
Practice locations: Conyers, GA

National Provider Directory

National Provider Directory

Locations

1815 Highway 138 SE
Ste 600
Conyers, GA 30013
Phone (770) 860-8333

1706 Highway 138 SE
Ste G
Conyers, GA 30013
Phone (770) 860-8333

208 Brookstone Pl
Ste B
Social Circle, GA 30025
Phone (770) 464-0644

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1255489712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 HIGHWAY 138 SE",
            "address_2": "SUITE 600",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132079",
            "telephone_number": "770-860-8333",
            "fax_number": "770-860-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 HIGHWAY 138 SE",
            "address_2": "SUITE 600",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132079",
            "telephone_number": "770-860-8333",
            "fax_number": "770-860-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THACKER CHIROPRACTIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "THACKER",
        "authorized_official_first_name": "MITCHEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "770-860-8333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR002342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.