Provider Demographics
NPI:1104295351
Name:REACH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:REACH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-981-5399
Mailing Address - Street 1:501 ROBERTS CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4941
Mailing Address - Country:US
Mailing Address - Phone:678-981-5399
Mailing Address - Fax:
Practice Address - Street 1:501 ROBERTS CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4941
Practice Address - Country:US
Practice Address - Phone:678-981-5399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty