| Thacker Chiropractic Clinic, Llc | |
|
1815 Highway 138 Se, Suite 600, Conyers, GA 30013-2079 | |
| (770) 860-8333 | |
| (770) 860-8833 |
| Full Name | Thacker Chiropractic Clinic, Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 1815 Highway 138 Se, Conyers, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255489712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | CHIR002342 (Georgia) | Primary |
| Provider Name | Steven M Thacker |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1598837296 PECOS PAC ID: 3678677572 Enrollment ID: I20111227000541 |
| Provider Name | Mitchel L Thacker |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1710059498 PECOS PAC ID: 5496859399 Enrollment ID: I20130624000549 |
| Mailing Address | Practice Location Address |
|---|---|
| Thacker Chiropractic Clinic, Llc 1815 Highway 138 Se, Suite 600, Conyers, GA 30013-2079 Ph: (770) 860-8333 | Thacker Chiropractic Clinic, Llc 1815 Highway 138 Se, Suite 600, Conyers, GA 30013-2079 Ph: (770) 860-8333 |
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