Healthcare Provider Details

I. General information

NPI: 1164840419
Provider Name (Legal Business Name): CTC INTEGRATED HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 ROSWELL RD STE A
SANDY SPRINGS GA
30328-3173
US

IV. Provider business mailing address

6600 ROSWELL RD STE A
SANDY SPRINGS GA
30328-3173
US

V. Phone/Fax

Practice location:
  • Phone: 404-531-0055
  • Fax: 404-531-0369
Mailing address:
  • Phone: 404-531-0055
  • Fax: 404-531-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL TODD HORTMAN JR.
Title or Position: OWNER
Credential: DC
Phone: 404-531-0055