Provider Demographics
NPI:1366721474
Name:PROACTIVE HEALTH THERAPEUTIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:PROACTIVE HEALTH THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKEIA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MANOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-224-9581
Mailing Address - Street 1:401 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1743
Mailing Address - Country:US
Mailing Address - Phone:912-224-9581
Mailing Address - Fax:
Practice Address - Street 1:10 HARRELL DR
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2005
Practice Address - Country:US
Practice Address - Phone:912-963-6711
Practice Address - Fax:912-963-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-06
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty