Provider Demographics
NPI:1487842910
Name:FORTIN FAMILY CHIROPRACTIC AND SPORTS HEALTH, INC.
Entity Type:Organization
Organization Name:FORTIN FAMILY CHIROPRACTIC AND SPORTS HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-476-9626
Mailing Address - Street 1:6000 MEDLOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE C-300
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8172
Mailing Address - Country:US
Mailing Address - Phone:770-476-9626
Mailing Address - Fax:770-476-1310
Practice Address - Street 1:6000 MEDLOCK BRIDGE PKWY
Practice Address - Street 2:SUITE C-300
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8172
Practice Address - Country:US
Practice Address - Phone:770-476-9626
Practice Address - Fax:770-476-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty