Provider Demographics
NPI:1205141264
Name:FAYETTE CHIROPRACTIC CENTER, INC
Entity type:Organization
Organization Name:FAYETTE CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-461-2225
Mailing Address - Street 1:1905 WINDHAM PARK NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4960
Mailing Address - Country:US
Mailing Address - Phone:770-461-2225
Mailing Address - Fax:770-461-0186
Practice Address - Street 1:106 GOVERNORS SQ
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4870
Practice Address - Country:US
Practice Address - Phone:770-461-2225
Practice Address - Fax:770-461-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty