Provider Demographics
NPI:1851540447
Name:BEAVER RUIN CHIROPRACTIC CENTER, INC
Entity type:Organization
Organization Name:BEAVER RUIN CHIROPRACTIC CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:COPELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-446-7305
Mailing Address - Street 1:720 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1325
Mailing Address - Country:US
Mailing Address - Phone:770-446-7305
Mailing Address - Fax:770-263-8710
Practice Address - Street 1:720 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1325
Practice Address - Country:US
Practice Address - Phone:770-446-7305
Practice Address - Fax:770-263-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty