Provider Demographics
NPI:1225047434
Name:BIG IDEA FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BIG IDEA FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-574-5227
Mailing Address - Street 1:3450 ACWORTH DUE WEST RD NW
Mailing Address - Street 2:STE 330
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1001
Mailing Address - Country:US
Mailing Address - Phone:678-574-5227
Mailing Address - Fax:678-574-5223
Practice Address - Street 1:3450 ACWORTH DUE WEST RD NW
Practice Address - Street 2:STE 330
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1001
Practice Address - Country:US
Practice Address - Phone:678-574-5227
Practice Address - Fax:678-574-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7830Medicare PIN