Healthcare Provider Details

I. General information

NPI: 1548701238
Provider Name (Legal Business Name): SUWANEE HAPPY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 PEACHTREE INDUSTRIAL BLVD
SUWANEE GA
30024-3043
US

IV. Provider business mailing address

686 PEACHTREE INDUSTRIAL BLVD
SUWANEE GA
30024-3043
US

V. Phone/Fax

Practice location:
  • Phone: 678-765-8073
  • Fax: 678-765-8074
Mailing address:
  • Phone: 678-765-8073
  • Fax: 678-765-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009172
License Number StateGA

VIII. Authorized Official

Name: DONGWOOK LEE
Title or Position: DIRECTOR
Credential: D.C
Phone: 678-765-8073