Provider Demographics
NPI:1689892986
Name:PEACHTREE CORNERS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:PEACHTREE CORNERS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCEP, FASA
Authorized Official - Phone:770-368-0333
Mailing Address - Street 1:3949 HOLCOMB BRIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2208
Mailing Address - Country:US
Mailing Address - Phone:770-368-0333
Mailing Address - Fax:770-368-0133
Practice Address - Street 1:3949 HOLCOMB BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2208
Practice Address - Country:US
Practice Address - Phone:770-368-0333
Practice Address - Fax:770-368-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty