Provider Demographics
NPI:1699958181
Name:A&W FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:A&W FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-285-1100
Mailing Address - Street 1:3894 DUE WEST RD NW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1071
Mailing Address - Country:US
Mailing Address - Phone:678-285-1100
Mailing Address - Fax:678-285-1102
Practice Address - Street 1:3894 DUE WEST RD NW
Practice Address - Street 2:SUITE 210
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1071
Practice Address - Country:US
Practice Address - Phone:678-285-1100
Practice Address - Fax:678-285-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHRVOtherMEDICARE LEGACY
GAGRP6465Medicare PIN
GAU99912Medicare UPIN