Provider Demographics
NPI:1659411007
Name:INTEGRATED CHIROPRACTIC
Entity Type:Organization
Organization Name:INTEGRATED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-231-8770
Mailing Address - Street 1:2964 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2153
Mailing Address - Country:US
Mailing Address - Phone:404-231-8770
Mailing Address - Fax:404-231-8760
Practice Address - Street 1:2964 PEACHTREE RD NW
Practice Address - Street 2:SUITE 105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2153
Practice Address - Country:US
Practice Address - Phone:404-231-8770
Practice Address - Fax:404-231-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty