=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073196903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEENA MARIE ACKER DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2021
-----------------------------------------------------
Last Update Date | 04/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1195 MILTON TER SE APT 1202
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30315-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-839-4566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 MEMORIAL DR SE UNIT 409
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30312-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-672-1672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR010458
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------