Provider Demographics
NPI:1932249562
Name:COOPERATIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:COOPERATIVE CHIROPRACTIC
Other - Org Name:DR. RAY MARQUEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-422-5052
Mailing Address - Street 1:1651 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4847
Mailing Address - Country:US
Mailing Address - Phone:770-422-5052
Mailing Address - Fax:770-422-8227
Practice Address - Street 1:1651 POWDER SPRINGS RD SW
Practice Address - Street 2:SUITE 3
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4847
Practice Address - Country:US
Practice Address - Phone:770-422-5052
Practice Address - Fax:770-422-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007145111N00000X
GA007157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1255384798OtherNPI- DR. MURRAY-GREEN
GA151709061OtherDR. M TAX ID
GA1720172430OtherNPI-DR. MARQUEZ
GA=========OtherDR G TAX ID NUMBER
GA=========OtherDR G TAX ID NUMBER