Provider Demographics
NPI:1225572563
Name:LLABB, LLC
Entity Type:Organization
Organization Name:LLABB, LLC
Other - Org Name:MUSCLE PERFORMANCE SCIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRONSON
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-456-5122
Mailing Address - Street 1:4018 NINE MCFARLAND DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3384
Mailing Address - Country:US
Mailing Address - Phone:678-456-5122
Mailing Address - Fax:678-456-5122
Practice Address - Street 1:4018 NINE MCFARLAND DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3384
Practice Address - Country:US
Practice Address - Phone:678-456-5122
Practice Address - Fax:678-456-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008932111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty