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General NPI Number Information
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NPI Number | 1134404403
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Entity Type | Organization
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Legal Business Name | JOURNEY FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 320 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5467
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Country | US
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Telephone | 678-333-7919
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Fax |
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Provider Business Mailing Address
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Address Line | 320 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5467
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Country | US
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Telephone | 678-333-7919
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | KEISHA BATES
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Credential |
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Telephone | 678-333-7919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR008842
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License Number State | GA
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