Provider Demographics
NPI:1487140893
Name:BHBD LLC
Entity type:Organization
Organization Name:BHBD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FEDORCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-573-2777
Mailing Address - Street 1:425 PEACHTREE PARKWAY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-573-2777
Mailing Address - Fax:770-888-1176
Practice Address - Street 1:425 PEACHTREE PARKWAY
Practice Address - Street 2:SUITE 315
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-573-2777
Practice Address - Fax:770-888-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009649111N00000X
GACHIR009575111N00000X
GACHIR009830111N00000X
FL068826208D00000X
GACHIR007276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty