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General NPI Number Information
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NPI Number | 1225400575
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Entity Type | Organization
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Legal Business Name | LIVING I.E. CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 1673 MILLER AVE SE
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City | MARIETTA
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State | GA
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Zip | 30060-4241
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Country | US
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Telephone | 765-620-4453
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Fax |
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Provider Business Mailing Address
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Address Line | 1673 MILLER AVE SE
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City | MARIETTA
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State | GA
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Zip | 30060-4241
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Country | US
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Telephone | 765-620-4453
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RYAN T SCHROCK
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Credential | D.C.
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Telephone | 765-620-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CHIR009579
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License Number State | GA
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