Provider Demographics
NPI:1699077701
Name:TRULIFE CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:TRULIFE CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-685-4483
Mailing Address - Street 1:126 N. PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153
Mailing Address - Country:US
Mailing Address - Phone:678-685-4483
Mailing Address - Fax:678-685-4487
Practice Address - Street 1:126 N. PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153
Practice Address - Country:US
Practice Address - Phone:678-685-4483
Practice Address - Fax:678-685-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008743261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1083915375OtherPROVIDER NPI NUMBER