Provider Demographics
NPI:1699713388
Name:LOGAN FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:LOGAN FAMILY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:770-345-7896
Mailing Address - Street 1:24 WALESKA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2739
Mailing Address - Country:US
Mailing Address - Phone:770-345-7896
Mailing Address - Fax:770-345-4096
Practice Address - Street 1:24 WALESKA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2739
Practice Address - Country:US
Practice Address - Phone:770-345-7896
Practice Address - Fax:770-345-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty