=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144349028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIE ELIZABETH PSZCZOLA D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5505 BELLS FERRY RD BUILDING 300 SUITE 240
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30102-7527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-445-1400
-----------------------------------------------------
Fax | 678-445-4585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2563
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30102-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-256-5699
-----------------------------------------------------
Fax | 678-445-4585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR005722
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------