Provider Demographics
NPI:1851478762
Name:LIFETOUCH CHIROPRACTIC
Entity Type:Organization
Organization Name:LIFETOUCH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-259-5599
Mailing Address - Street 1:513 BENJAMIN WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4682
Mailing Address - Country:US
Mailing Address - Phone:706-259-5599
Mailing Address - Fax:706-259-9848
Practice Address - Street 1:513 BENJAMIN WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4682
Practice Address - Country:US
Practice Address - Phone:706-259-5599
Practice Address - Fax:706-259-9848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETOUCH CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3636Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER