Healthcare Provider Details

I. General information

NPI: 1932249562
Provider Name (Legal Business Name): COOPERATIVE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 POWDER SPRINGS RD SW SUITE 3
MARIETTA GA
30064-4847
US

IV. Provider business mailing address

1651 POWDER SPRINGS RD SW SUITE 3
MARIETTA GA
30064-4847
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-5052
  • Fax: 770-422-8227
Mailing address:
  • Phone: 770-422-5052
  • Fax: 770-422-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007157
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007145
License Number StateGA

VIII. Authorized Official

Name: MS. ERIN S CORRIGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-422-5052