Healthcare Provider Details

I. General information

NPI: 1043639883
Provider Name (Legal Business Name): POGRELIS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 TOWNE LAKE PKWY
WOODSTOCK GA
30189-5525
US

IV. Provider business mailing address

1020 CHEROKEE TRL
WOODSTOCK GA
30189-3606
US

V. Phone/Fax

Practice location:
  • Phone: 770-592-2505
  • Fax: 770-592-2433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBORAH A POGRELIS
Title or Position: OWNER/MEMBER
Credential: DC
Phone: 404-509-5201