100yeardoc, LLC

NPI #1194291021 in Marietta, Georgia

Provider Information

NPI Number: 1194291021
Entity Type: Organization
Organization Name: 100yeardoc, LLC
Primary Specialty: Chiropractor
Enumeration Date: Oct 18, 2018
Last Updated: Oct 22, 2018

Practice Location

Address: 1135 S MARIETTA PKWY SE
City: Marietta
State: Georgia
ZIP Code: 30060-2830
Phone: (770) 422-9288

Authorized Official

Name: JOSHUA M WILSON, DC
Title: CHIROPRACTOR
Phone: (770) 422-9288

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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