Provider Demographics
NPI:1497466957
Name:LIFEGIVING CHIROPRACTIC SUWANEE LLC
Entity Type:Organization
Organization Name:LIFEGIVING CHIROPRACTIC SUWANEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CARRAU-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-432-3986
Mailing Address - Street 1:1324 GLEN CEDARS DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7607
Mailing Address - Country:US
Mailing Address - Phone:787-432-3986
Mailing Address - Fax:
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 3110
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4544
Practice Address - Country:US
Practice Address - Phone:787-432-3986
Practice Address - Fax:770-943-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty