Provider Demographics
NPI:1073896718
Name:COVENANT CHIROPRACTIC, L.C.C.
Entity Type:Organization
Organization Name:COVENANT CHIROPRACTIC, L.C.C.
Other - Org Name:SEGAL FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-487-7970
Mailing Address - Street 1:14 EASTBROOK BND
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1530
Mailing Address - Country:US
Mailing Address - Phone:770-487-7970
Mailing Address - Fax:770-487-7970
Practice Address - Street 1:14 EASTBROOK BND
Practice Address - Street 2:SUITE 204
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1530
Practice Address - Country:US
Practice Address - Phone:770-487-7970
Practice Address - Fax:770-487-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty