OrganizationCreekside Chiropractic LlcChiropractorChiropractic ProvidersPractice Address5947 Holly Springs Pkwy, Suite 308, Holly Springs, GA 30188-2447(770) 744-8393PECOS EnrollmentBased on the most recent information from CMS, provider Creekside Chiropractic Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1376916452Provider TypeOrganizationFull NameCreekside Chiropractic LlcSubpartNoEnumeration Date11/11/2015Last Updated11/11/2015Contact InformationPractice LocationPractice Address5947 Holly Springs Pkwy, Suite 308, Holly Springs, GA 30188-2447Phone(770) 744-8393FaxUnlisted FaxMailing LocationMailing Address5947 Holly Springs Pkwy, Suite 308, Holly Springs, GA 30188-2447Phone(770) 744-8393FaxUnlisted FaxAuthorized OfficialNameJames, Tracy Ivy (Partner)Phone(770) 744-8393Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicenseCHIR006622GeorgiaProvider IdentifiersIDDescriptionIssuerID202I354499DescriptionOtherIssuerMEDICARE PTANGeorgiaID202I358649DescriptionOtherIssuerMEDICAREGeorgia