Provider Demographics
NPI:1841802014
Name:LOST MOUNTAIN CHIROPRACTIC FAMILY AND PEDIATRICS LLC
Entity Type:Organization
Organization Name:LOST MOUNTAIN CHIROPRACTIC FAMILY AND PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:RODEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-218-0400
Mailing Address - Street 1:1685 MARS HILL RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7180
Mailing Address - Country:US
Mailing Address - Phone:770-218-0400
Mailing Address - Fax:770-218-1160
Practice Address - Street 1:1685 MARS HILL RD NW STE 103
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7180
Practice Address - Country:US
Practice Address - Phone:770-218-0400
Practice Address - Fax:770-218-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty