Provider Demographics
NPI:1649723776
Name:BROOKHAVEN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BROOKHAVEN CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-938-4606
Mailing Address - Street 1:4060 PEACHTREE RD NE
Mailing Address - Street 2:SUITE J
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3020
Mailing Address - Country:US
Mailing Address - Phone:404-767-8873
Mailing Address - Fax:404-231-9953
Practice Address - Street 1:4060 PEACHTREE RD NE
Practice Address - Street 2:SUITE J
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3020
Practice Address - Country:US
Practice Address - Phone:404-767-8873
Practice Address - Fax:404-231-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty