Provider Demographics
NPI:1811123243
Name:CHIROPRACTIC AT THE LIGHTHOUSE, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC AT THE LIGHTHOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-971-8115
Mailing Address - Street 1:2078 SHERWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7324
Mailing Address - Country:US
Mailing Address - Phone:404-358-5250
Mailing Address - Fax:
Practice Address - Street 1:62 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7316
Practice Address - Country:US
Practice Address - Phone:770-971-8115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003767172M00000X
GACHIR008436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty