Provider Demographics
NPI:1124108311
Name:LOVING CARE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:LOVING CARE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELBONIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-884-3778
Mailing Address - Street 1:5336 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3031
Mailing Address - Country:US
Mailing Address - Phone:678-884-3778
Mailing Address - Fax:866-810-3847
Practice Address - Street 1:5336 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3031
Practice Address - Country:US
Practice Address - Phone:678-884-3778
Practice Address - Fax:866-810-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1417049172OtherINDIVIDUAL