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General NPI Number Information
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NPI Number | 1811123243
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC AT THE LIGHTHOUSE, LLC
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 62 SHAWNEE LN
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City | MARIETTA
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State | GA
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Zip | 30067-7316
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Country | US
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Telephone | 770-971-8115
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Fax |
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Provider Business Mailing Address
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Address Line | 2078 SHERWOOD DR SE
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City | MARIETTA
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State | GA
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Zip | 30067-7324
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Country | US
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Telephone | 404-358-5250
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURELYN BARNETT
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Credential | DC
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Telephone | 770-971-8115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MT003767
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR008436
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License Number State | GA
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