=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073639464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTER HEALTH NATURALLY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2790 SANDY PLAINS RD SUITE 100
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-565-8151
-----------------------------------------------------
Fax | 770-565-8649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2790 SANDY PLAINS RD SUITE 100
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-565-8151
-----------------------------------------------------
Fax | 770-565-8649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. JASIA LACHCIK COSTA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 770-565-8151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | GA 6071
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------