Provider Demographics
NPI:1407110463
Name:HEALTHY PERFORMANCE CHIROPRACTIC,LLC
Entity Type:Organization
Organization Name:HEALTHY PERFORMANCE CHIROPRACTIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-578-0631
Mailing Address - Street 1:597 SAINT JAMES WALK SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7165
Mailing Address - Country:US
Mailing Address - Phone:404-578-0631
Mailing Address - Fax:
Practice Address - Street 1:700 HEMBREE PL
Practice Address - Street 2:SUITE C
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3862
Practice Address - Country:US
Practice Address - Phone:404-578-0631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty