Provider Demographics
NPI:1598140279
Name:100 PERCENT CHIROPRACTIC ATLANTA FIVE LLC
Entity type:Organization
Organization Name:100 PERCENT CHIROPRACTIC ATLANTA FIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JOCYNTH CLOSETH
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-457-1571
Mailing Address - Street 1:4490 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:STE. D
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6237
Mailing Address - Country:US
Mailing Address - Phone:770-457-1571
Mailing Address - Fax:770-457-1572
Practice Address - Street 1:4490 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:SUITE D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6237
Practice Address - Country:US
Practice Address - Phone:770-457-1571
Practice Address - Fax:770-457-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty