Provider Demographics
NPI:1881962942
Name:LAKE CITY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:LAKE CITY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-529-0566
Mailing Address - Street 1:4500 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5400
Mailing Address - Country:US
Mailing Address - Phone:770-529-0566
Mailing Address - Fax:770-529-0572
Practice Address - Street 1:4500 MAIN ST. SUITE104
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5400
Practice Address - Country:US
Practice Address - Phone:770-529-0566
Practice Address - Fax:770-529-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty