Provider Demographics
NPI:1538686258
Name:CHIROPRACTIC GAME CHANGERS, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC GAME CHANGERS, LLC
Other - Org Name:LIFEGIVING CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-943-1425
Mailing Address - Street 1:2615 E WEST CONNECTOR STE 108
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6854
Mailing Address - Country:US
Mailing Address - Phone:770-943-1425
Mailing Address - Fax:770-943-1452
Practice Address - Street 1:2615 E WEST CONNECTOR STE 108
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6854
Practice Address - Country:US
Practice Address - Phone:770-943-1425
Practice Address - Fax:770-943-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR008695OtherCHIROPRACTIC LICENSE