Provider Demographics
NPI:1407032840
Name:LIGHTHOUSE FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LIGHTHOUSE FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEWIS-PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-838-4433
Mailing Address - Street 1:4935 STEWART MILL RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6733
Mailing Address - Country:US
Mailing Address - Phone:678-838-4433
Mailing Address - Fax:678-838-4093
Practice Address - Street 1:4935 STEWART MILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6733
Practice Address - Country:US
Practice Address - Phone:678-838-4433
Practice Address - Fax:678-838-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00106701Medicare UPIN
GA35ZCHMVMedicare PIN