Provider Demographics
NPI:1164138327
Name:PHAVORACHITH, BRANDI CHRISTINE (DC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:CHRISTINE
Last Name:PHAVORACHITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:PHAVORACHITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3105 CREEKSIDE VILLAGE DR NW STE 710
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4218
Mailing Address - Country:US
Mailing Address - Phone:678-996-0373
Mailing Address - Fax:404-320-6073
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW STE 710
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4218
Practice Address - Country:US
Practice Address - Phone:678-996-0373
Practice Address - Fax:404-320-6073
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor