Healthcare Provider Details

I. General information

NPI: 1841531688
Provider Name (Legal Business Name): SUWANEE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 LAWRENCEVILLE SUWANEE RD SUITE 155
SUWANEE GA
30024-2671
US

IV. Provider business mailing address

2790 LAWRENCEVILLE SUWANEE RD SUITE 155
SUWANEE GA
30024-2671
US

V. Phone/Fax

Practice location:
  • Phone: 770-932-2014
  • Fax: 770-932-2058
Mailing address:
  • Phone: 770-932-2014
  • Fax: 770-932-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008941
License Number StateGA

VIII. Authorized Official

Name: DR. JAY LEE
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 770-932-2014