Provider Demographics
NPI:1588062350
Name:LANDRY, AMBER (DC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 POWERS FERRY RD SE BLDG 2-175
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9450
Mailing Address - Country:US
Mailing Address - Phone:770-690-8959
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE BLDG 2-175
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9450
Practice Address - Country:US
Practice Address - Phone:678-761-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008898111N00000X
GACHIR009427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor