Provider Demographics
NPI:1720345648
Name:ELAN CHIROPRACTIC AND FAMILY WELLNESS LLC
Entity Type:Organization
Organization Name:ELAN CHIROPRACTIC AND FAMILY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-205-0709
Mailing Address - Street 1:1272 HOUNDSLAKE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-8715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2896 CHAMBLEE TUCKER RD STE 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4009
Practice Address - Country:US
Practice Address - Phone:770-457-0584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty