Provider Demographics
NPI:1255152138
Name:NATURALLY ROOTED CHIROPRACTIC PC
Entity type:Organization
Organization Name:NATURALLY ROOTED CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONJOIE-MATHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-808-3356
Mailing Address - Street 1:3245 AMBERGROVE TRCE
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6811
Mailing Address - Country:US
Mailing Address - Phone:404-808-3356
Mailing Address - Fax:
Practice Address - Street 1:2300 LIAM AVE STE 204
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2264
Practice Address - Country:US
Practice Address - Phone:404-808-3356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty