Provider Demographics
NPI:1477043123
Name:BE THE LIGHT CHIROPRACTIC
Entity Type:Organization
Organization Name:BE THE LIGHT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-328-7146
Mailing Address - Street 1:3750 VENTURE DR STE D9
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1811
Mailing Address - Country:US
Mailing Address - Phone:678-328-7146
Mailing Address - Fax:
Practice Address - Street 1:3750 VENTURE DR STE D9
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1811
Practice Address - Country:US
Practice Address - Phone:678-328-7146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty