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General NPI Number Information
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NPI Number | 1396987889
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Entity Type | Organization
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Legal Business Name | NEW LIFE CHIROPRACTIC & WELLNESS CENTER
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 590 COBB PKWY S
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City | MARIETTA
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State | GA
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Zip | 30060-6517
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Country | US
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Telephone | 770-427-0044
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Fax | 770-428-9695
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Provider Business Mailing Address
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Address Line | 590 COBB PKWY S
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City | MARIETTA
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State | GA
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Zip | 30060-6517
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Country | US
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Telephone | 770-427-0044
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. LARONA GORE
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Credential | B.S., D.C.
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Telephone | 404-641-0524
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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 | CHIR008408
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License Number State | GA
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