Provider Demographics
NPI:1659991362
Name:LAKE POINTE WELLNESS CENTER
Entity Type:Organization
Organization Name:LAKE POINTE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHREIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-974-5215
Mailing Address - Street 1:3450 ACWORTH DUE WEST RD NW STE 500
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1121
Mailing Address - Country:US
Mailing Address - Phone:770-974-5215
Mailing Address - Fax:770-992-3676
Practice Address - Street 1:3450 ACWORTH DUE WEST RD NW STE 500
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1121
Practice Address - Country:US
Practice Address - Phone:770-974-5215
Practice Address - Fax:770-992-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1881850733OtherNPI