Provider Demographics
NPI:1306193289
Name:BTLCC CORP
Entity Type:Organization
Organization Name:BTLCC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-522-9221
Mailing Address - Street 1:12 STONEMILL CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1792
Mailing Address - Country:US
Mailing Address - Phone:678-522-9221
Mailing Address - Fax:
Practice Address - Street 1:1468 LAFAYETTE PKWY
Practice Address - Street 2:STE 140
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2605
Practice Address - Country:US
Practice Address - Phone:706-882-5737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK TO LIFE CHIROPRACTIC CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty