=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013214840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUTRITIONAL HEALTH IMPROVEMENT CENTER, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2011
-----------------------------------------------------
Last Update Date | 02/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2440 SANDY PLAINS RD BUILDING 3, SUITE 115
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-7217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-693-8813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2440 SANDY PLAINS RD BUILDING 3, SUITE 115
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-7217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-873-9637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ SOLE MEMBER
-----------------------------------------------------
Name | DR. MELISSA GUNTHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-873-9637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR007814
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------