Provider Demographics
NPI:1043426489
Name:LAWRENCEVILLE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:LAWRENCEVILLE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONINAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-225-4800
Mailing Address - Street 1:295 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4877
Mailing Address - Country:US
Mailing Address - Phone:678-225-4800
Mailing Address - Fax:678-225-4801
Practice Address - Street 1:295 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4877
Practice Address - Country:US
Practice Address - Phone:678-225-4800
Practice Address - Fax:678-225-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1214500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1214500OtherBUSINESS LICENSE
GAGRP6298Medicare ID - Type Unspecified