=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194272393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARNES FAMILY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2016
-----------------------------------------------------
Last Update Date | 12/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 SHALLOWFORD RD STE 105C
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-657-7463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2323 SHALLOWFORD RD STE 105C
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-657-7463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC/OWNER
-----------------------------------------------------
Name | DR. TIFFANY DANIELLE STARNES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 770-873-2087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR009609
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------