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General NPI Number Information
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NPI Number | 1578201240
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Entity Type | Organization
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Legal Business Name | LINE BACKERS LLC
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 2730 HIGHWAY 34 E STE D
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City | NEWNAN
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State | GA
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Zip | 30265-6404
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Country | US
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Telephone | 678-416-1488
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 HIGHWAY 34 E STE D
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City | NEWNAN
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State | GA
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Zip | 30265-6404
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Country | US
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Telephone | 678-416-1488
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Fax |
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Authorized Official
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Title or Position | OWNING MEMBER
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Name | DR. GERREN Q BRITTIAN
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Credential | DC
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Telephone | 678-416-1488
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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 |
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License Number State |
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