Provider Demographics
NPI:1255019915
Name:THE RIVER OF LIFE CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:THE RIVER OF LIFE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-787-2237
Mailing Address - Street 1:2987 WITHERS WAY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4447
Mailing Address - Country:US
Mailing Address - Phone:404-787-2237
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 510
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7153
Practice Address - Country:US
Practice Address - Phone:404-787-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty