Provider Demographics
NPI:1841531688
Name:SUWANEE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SUWANEE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-932-2014
Mailing Address - Street 1:2790 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2671
Mailing Address - Country:US
Mailing Address - Phone:770-932-2014
Mailing Address - Fax:770-932-2058
Practice Address - Street 1:2790 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 155
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2671
Practice Address - Country:US
Practice Address - Phone:770-932-2014
Practice Address - Fax:770-932-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty