Healthcare Provider Details

I. General information

NPI: 1811123243
Provider Name (Legal Business Name): CHIROPRACTIC AT THE LIGHTHOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SHAWNEE LN
MARIETTA GA
30067-7316
US

IV. Provider business mailing address

2078 SHERWOOD DR SE
MARIETTA GA
30067-7324
US

V. Phone/Fax

Practice location:
  • Phone: 770-971-8115
  • Fax:
Mailing address:
  • Phone: 404-358-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008436
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT003767
License Number StateGA

VIII. Authorized Official

Name: DR. LAURELYN BARNETT
Title or Position: OWNER
Credential: DC
Phone: 770-971-8115