Provider Demographics
NPI:1851882369
Name:MAHAN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MAHAN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-970-3752
Mailing Address - Street 1:3295 DOGWOOD LN UNIT D
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-1507
Mailing Address - Country:US
Mailing Address - Phone:706-970-3752
Mailing Address - Fax:
Practice Address - Street 1:3295 DOGWOOD LN UNIT D
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-1507
Practice Address - Country:US
Practice Address - Phone:706-970-3752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty