=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750231031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 100 YEAR LIFESTYLE CHIROPRACTIC & DECOMPRESSION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 JOHNSON FERRY RD STE 4230
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30068-4952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-509-9938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 JOHNSON FERRY RD STE 4230
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30068-4952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-509-9938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER, OWNER, AO
-----------------------------------------------------
Name | DR. CORY PLASKER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 770-509-9938
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------