Provider Demographics
NPI:1396860755
Name:FALITE FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FALITE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARCY
Authorized Official - Last Name:FALITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-667-2232
Mailing Address - Street 1:2910 VAUGHAN DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7511
Mailing Address - Country:US
Mailing Address - Phone:770-667-2232
Mailing Address - Fax:770-667-6585
Practice Address - Street 1:2910 VAUGHAN DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7511
Practice Address - Country:US
Practice Address - Phone:770-667-2232
Practice Address - Fax:770-667-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2014-07-18
Deactivation Date:2014-02-10
Deactivation Code:
Reactivation Date:2014-07-18
Provider Licenses
StateLicense IDTaxonomies
GA5418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA858725OtherBLUECROSS BLUESHIELD PIN