Provider Demographics
NPI:1861675811
Name:SPORTS CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:SPORTS CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-993-3200
Mailing Address - Street 1:8460 HOLCOMB BRIDGE RD
Mailing Address - Street 2:120
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6868
Mailing Address - Country:US
Mailing Address - Phone:770-993-3200
Mailing Address - Fax:770-641-8017
Practice Address - Street 1:8460 HOLCOMB BRIDGE RD
Practice Address - Street 2:120
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6868
Practice Address - Country:US
Practice Address - Phone:770-993-3200
Practice Address - Fax:770-641-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR00007311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty