Provider Demographics
NPI:1043639883
Name:POGRELIS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:POGRELIS CHIROPRACTIC LLC
Other - Org Name:DR. DEBORAH POGRELIS@RIBLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:POGRELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-509-5201
Mailing Address - Street 1:1020 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2453 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5525
Practice Address - Country:US
Practice Address - Phone:770-592-2505
Practice Address - Fax:770-592-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I350495OtherPTAN
GA1447336227OtherNPI
GAU60859Medicare UPIN