=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386082493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOUCH OF LIFE FAMILY CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2013
-----------------------------------------------------
Last Update Date | 06/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5835 CAMPBELLTON RD SW SUITE 204
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-349-3601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5835 CAMPBELLTON RD SW SUITE 204
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. PATRICE THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 40403690998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | CHIR008987
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------