Provider Demographics
NPI:1750602595
Name:LAMBERT CHIROPRACTIC AND WELLNESS CENTER PC
Entity type:Organization
Organization Name:LAMBERT CHIROPRACTIC AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SECORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-987-0771
Mailing Address - Street 1:5353 FAIRINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1164
Mailing Address - Country:US
Mailing Address - Phone:770-987-0771
Mailing Address - Fax:770-987-0737
Practice Address - Street 1:5353 FAIRINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1164
Practice Address - Country:US
Practice Address - Phone:770-987-0771
Practice Address - Fax:770-987-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV07301Medicare UPIN