Provider Demographics
NPI:1740456011
Name:PORTER FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:PORTER FAMILY CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-1889
Mailing Address - Street 1:2655 DALLAS HWY SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2597
Mailing Address - Country:US
Mailing Address - Phone:770-427-1889
Mailing Address - Fax:770-427-7513
Practice Address - Street 1:2655 DALLAS HWY SW
Practice Address - Street 2:SUITE 110
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2597
Practice Address - Country:US
Practice Address - Phone:770-427-1889
Practice Address - Fax:770-427-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00784616AMedicaid
GA35ZCFDJMedicare PIN