Provider Demographics
NPI:1750652251
Name:LINE CHIROPRACTIC INC
Entity type:Organization
Organization Name:LINE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-814-7416
Mailing Address - Street 1:2550 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4122
Mailing Address - Country:US
Mailing Address - Phone:770-814-7400
Mailing Address - Fax:770-814-7442
Practice Address - Street 1:2550 PLEASANT HILL RD
Practice Address - Street 2:SUITE 124
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4122
Practice Address - Country:US
Practice Address - Phone:770-814-7400
Practice Address - Fax:770-814-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008420111N00000X
GACHIR006771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty