Healthcare Provider Details

I. General information

NPI: 1740986454
Provider Name (Legal Business Name): BI-COUNTY CHIROPRACTIC AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 CANTON RD STE 301
MARIETTA GA
30066-2896
US

IV. Provider business mailing address

3417 CANTON RD STE 301
MARIETTA GA
30066-2896
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-5551
  • Fax: 770-424-5553
Mailing address:
  • Phone: 770-424-5551
  • Fax: 770-424-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS B PETTIT
Title or Position: OWNER
Credential: D.C.
Phone: 908-801-7777