Provider Demographics
NPI:1922384155
Name:SUGARLOAF FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SUGARLOAF FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CZOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-994-7988
Mailing Address - Street 1:3157 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9490
Mailing Address - Country:US
Mailing Address - Phone:678-828-4114
Mailing Address - Fax:
Practice Address - Street 1:3157 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9490
Practice Address - Country:US
Practice Address - Phone:678-828-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty