Provider Demographics
NPI:1356851984
Name:DR. SAMUEL WIREMAN, LLC
Entity Type:Organization
Organization Name:DR. SAMUEL WIREMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WIREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-681-2829
Mailing Address - Street 1:19 RIDGE RUN SE APT O
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8229
Mailing Address - Country:US
Mailing Address - Phone:215-681-2829
Mailing Address - Fax:
Practice Address - Street 1:1409 N HIGHLAND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3300
Practice Address - Country:US
Practice Address - Phone:404-860-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty