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General NPI Number Information
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NPI Number | 1518381938
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Entity Type | Organization
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Legal Business Name | SPORTS PERFORMANCE CONCEPTS, LLC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 3985 LAKEFIELD CT STE 206
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City | SUWANEE
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State | GA
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Zip | 30024-1209
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Country | US
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Telephone | 470-239-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 3985 LAKEFIELD CT STE 206
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City | SUWANEE
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State | GA
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Zip | 30024-1209
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Country | US
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Telephone | 470-239-0770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN ASHLEY CORTJENS
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Credential | DC, CCSP, QME, IIE
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Telephone | 470-239-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIR009018
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License Number State | GA
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