Provider Demographics
NPI:1306234430
Name:CREEKVIEW FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CREEKVIEW FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GATELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-406-6476
Mailing Address - Street 1:4905 ALABAMA RD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1699
Mailing Address - Country:US
Mailing Address - Phone:770-406-6476
Mailing Address - Fax:
Practice Address - Street 1:4905 ALABAMA RD NE
Practice Address - Street 2:SUITE 360
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1699
Practice Address - Country:US
Practice Address - Phone:770-406-6476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty