Provider Demographics
NPI:1457552549
Name:SANDY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SANDY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:SANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-483-6780
Mailing Address - Street 1:207 E DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3709
Mailing Address - Country:US
Mailing Address - Phone:404-483-6780
Mailing Address - Fax:
Practice Address - Street 1:1364 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1519
Practice Address - Country:US
Practice Address - Phone:404-483-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty