Provider Demographics
NPI:1861853103
Name:LOVE, AMANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3621
Mailing Address - Country:US
Mailing Address - Phone:770-450-1200
Mailing Address - Fax:678-648-5504
Practice Address - Street 1:1642 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3621
Practice Address - Country:US
Practice Address - Phone:770-450-1200
Practice Address - Fax:678-648-5504
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor