Provider Demographics
NPI:1841962081
Name:200 CHIRO CHRISTOFFER, LLC
Entity type:Organization
Organization Name:200 CHIRO CHRISTOFFER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURNTEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-640-9195
Mailing Address - Street 1:1738 DAYTON BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-2188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1738 DAYTON BLVD STE 114
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-2188
Practice Address - Country:US
Practice Address - Phone:719-217-0895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty