Provider Demographics
NPI:1154408078
Name:LIFETOUCH CHIROPRACTIC
Entity type:Organization
Organization Name:LIFETOUCH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-337-5318
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:GA
Mailing Address - Zip Code:30139-0579
Mailing Address - Country:US
Mailing Address - Phone:706-337-5318
Mailing Address - Fax:706-337-5493
Practice Address - Street 1:2265 HWY 411 SE
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT
Practice Address - State:GA
Practice Address - Zip Code:30139
Practice Address - Country:US
Practice Address - Phone:706-337-5318
Practice Address - Fax:706-337-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER