Provider Demographics
NPI:1346379435
Name:TOWNE LAKE FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:TOWNE LAKE FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-592-1877
Mailing Address - Street 1:1000 WYNGATE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6981
Mailing Address - Country:US
Mailing Address - Phone:770-592-1877
Mailing Address - Fax:
Practice Address - Street 1:1000 WYNGATE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6981
Practice Address - Country:US
Practice Address - Phone:770-592-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T33175Medicare UPIN
35ZCDBDMedicare ID - Type Unspecified