Provider Demographics
NPI:1477714186
Name:BRANNAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BRANNAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-517-5610
Mailing Address - Street 1:PO BOX 2563
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30107
Mailing Address - Country:US
Mailing Address - Phone:770-517-5610
Mailing Address - Fax:770-517-5611
Practice Address - Street 1:104 MIRRAMONT LAKE DR.
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3018
Practice Address - Country:US
Practice Address - Phone:770-517-5610
Practice Address - Fax:770-517-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty