Healthcare Provider Details

I. General information

NPI: 1487827390
Provider Name (Legal Business Name): 14TH STREET CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 14TH ST NE STE D
ATLANTA GA
30309-3696
US

IV. Provider business mailing address

244 14TH ST NE STE D
ATLANTA GA
30309-3696
US

V. Phone/Fax

Practice location:
  • Phone: 678-244-9604
  • Fax:
Mailing address:
  • Phone: 678-244-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008296
License Number StateGA

VIII. Authorized Official

Name: DR. NORMAN T ENG
Title or Position: OWNER
Credential: D.C.
Phone: 678-244-9604