NPIMap

Organization Active NPI

Lagrange Clinic of Chiropractic Incorporated

  • Chiropractor
  • Lagrange, GA
National Provider Identifier
1346452596
Registry record updated Feb 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR007612 Issued in GA
Legal business name
LAGRANGE CLINIC OF CHIROPRACTIC INCORPORATED
Practice address
403 Ridley Ave
Lagrange, GA 30240-2231
Phone
(706) 882-1000
NPI assigned
May 3, 2007
Last updated
Feb 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2013

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

Authorized official

Name
Mary N Garrison
Title
Office Manager
Phone
(706) 882-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIR007612 GA Primary

Addresses

Primary practice location

403 Ridley Ave
Lagrange, GA 30240-2231

Mailing address

PO Box 1010
Lagrange, GA 30241-0018
Phone (706) 882-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050510001110 GA Part B Supplier - Clinic/Group Practice 4587604491 Receives reassigned benefits from 1 practitioner
Practice locations: Lagrange, GA

National Provider Directory

National Provider Directory

Locations

101 Harwell Ave
Lagrange, GA 30240
Phone (706) 882-1000

300 Mooty Bridge Rd
Ste 120
Lagrange, GA 30240
Phone (706) 882-1000

403 Ridley Ave
Lagrange, GA 30240
Phone (706) 756-1970

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361836800000",
    "number": "1346452596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302410018",
            "telephone_number": "706-882-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402231",
            "telephone_number": "706-882-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGRANGE CLINIC OF CHIROPRACTIC INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2013-02-26",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-882-1000"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR007612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; 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.