Provider Demographics
NPI:1578201240
Name:LINE BACKERS LLC
Entity Type:Organization
Organization Name:LINE BACKERS LLC
Other - Org Name:BRITTIAN CHIROPRACTIC NEWNAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERREN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BRITTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-416-1488
Mailing Address - Street 1:2730 HIGHWAY 34 E STE D
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6404
Mailing Address - Country:US
Mailing Address - Phone:678-416-1488
Mailing Address - Fax:
Practice Address - Street 1:2730 HIGHWAY 34 E STE D
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6404
Practice Address - Country:US
Practice Address - Phone:678-416-1488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty