Provider Demographics
NPI:1942931845
Name:SUTTLES FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SUTTLES FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:SUTTLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-340-7671
Mailing Address - Street 1:1012 EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-4404
Mailing Address - Country:US
Mailing Address - Phone:706-340-7671
Mailing Address - Fax:
Practice Address - Street 1:1441 HARTWELL HWY
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-3405
Practice Address - Country:US
Practice Address - Phone:706-340-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01084237OtherPLAN NETWORK ID
GA11614811OtherCAQH
CHIR007885OtherSTATE LICENSE