Healthcare Provider Details

I. General information

NPI: 1477669752
Provider Name (Legal Business Name): LOUIS M. OKUN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 SHANNON PKWY SUITE # 13-14
UNION CITY GA
30291-2073
US

IV. Provider business mailing address

6703 SHANNON PKWY SUITE # 13-14
UNION CITY GA
30291-2073
US

V. Phone/Fax

Practice location:
  • Phone: 770-964-3334
  • Fax: 770-306-2680
Mailing address:
  • Phone: 770-964-3334
  • Fax: 770-306-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR002848
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: