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General NPI Number Information
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NPI Number | 1821206368
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Entity Type | Organization
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Legal Business Name | HEALTH FOR LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2080 FAIRBURN RD STE F
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 770-489-0187
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Fax | 770-920-0364
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Provider Business Mailing Address
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Address Line | POBOX 1171
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City | DOUGLASVILLE
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State | GA
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Zip | 30133-1171
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Country | US
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Telephone | 770-489-0187
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Fax | 770-920-0364
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDMOND E. HATTAWAY
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Credential | DC
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Telephone | 770-489-0187
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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 | CHIR002812
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License Number State | GA
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