Provider Demographics
NPI:1093341737
Name:CONNECT MY BRAIN
Entity Type:Organization
Organization Name:CONNECT MY BRAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC MS DICCP BCN CAS
Authorized Official - Phone:678-501-5172
Mailing Address - Street 1:4930 LONG ISLAND TER
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2572
Mailing Address - Country:US
Mailing Address - Phone:678-787-3744
Mailing Address - Fax:
Practice Address - Street 1:4930 LONG ISLAND TER
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2572
Practice Address - Country:US
Practice Address - Phone:678-787-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty