Provider Demographics
NPI:1205370947
Name:HOLISTIC2HEALTH WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HOLISTIC2HEALTH WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:SHANEE
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-316-5819
Mailing Address - Street 1:1406 POST OAK DR
Mailing Address - Street 2:UNIT H
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-3136
Mailing Address - Country:US
Mailing Address - Phone:312-316-5819
Mailing Address - Fax:
Practice Address - Street 1:1406 POST OAK DR
Practice Address - Street 2:UNIT H
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-3136
Practice Address - Country:US
Practice Address - Phone:312-316-5819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty