Provider Demographics
NPI:1821128174
Name:HEALTHSPROUT LLC
Entity Type:Organization
Organization Name:HEALTHSPROUT LLC
Other - Org Name:HEALTHSPROUT CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-517-2240
Mailing Address - Street 1:180 TOWNE LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4843
Mailing Address - Country:US
Mailing Address - Phone:770-517-2240
Mailing Address - Fax:770-587-2286
Practice Address - Street 1:180 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4843
Practice Address - Country:US
Practice Address - Phone:770-517-2240
Practice Address - Fax:770-587-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4288Medicare PIN