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General NPI Number Information
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NPI Number | 1689892986
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Entity Type | Organization
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Legal Business Name | PEACHTREE CORNERS CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3949 HOLCOMB BRIDGE RD STE 201
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City | NORCROSS
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State | GA
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Zip | 30092-2208
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Country | US
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Telephone | 770-368-0333
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Fax | 770-368-0133
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Provider Business Mailing Address
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Address Line | 3949 HOLCOMB BRIDGE RD STE 201
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City | NORCROSS
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State | GA
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Zip | 30092-2208
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Country | US
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Telephone | 770-368-0333
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Fax | 770-368-0133
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Authorized Official
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Title or Position | OWNERPRESIDENT
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Name | FREDRICK NEAL
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Credential | D.C., C.C.E.P., FASA
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Telephone | 770-368-0333
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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 | 2756
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License Number State | GA
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