Provider Demographics
NPI:1588960835
Name:PEACHTREE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:PEACHTREE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-232-1313
Mailing Address - Street 1:3294 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8322
Mailing Address - Country:US
Mailing Address - Phone:770-232-1313
Mailing Address - Fax:770-232-1317
Practice Address - Street 1:3294 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 2005
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8322
Practice Address - Country:US
Practice Address - Phone:770-232-1313
Practice Address - Fax:770-232-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008322261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center