Provider Demographics
NPI:1033309299
Name:MCINTYRE FAMILY CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MCINTYRE FAMILY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-952-9664
Mailing Address - Street 1:1275 POWERS FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9486
Mailing Address - Country:US
Mailing Address - Phone:770-952-9664
Mailing Address - Fax:770-952-2962
Practice Address - Street 1:1275 POWERS FERRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9486
Practice Address - Country:US
Practice Address - Phone:770-952-9664
Practice Address - Fax:770-952-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4899OtherMEDICARE GROUP NUMBER
GA35ZCHDBMedicare UPIN