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General NPI Number Information
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NPI Number | 1831262914
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Entity Type | Organization
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Legal Business Name | AC CHIROPRACTIC LIFE CENTER
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 217 SCENIC HWY # 124
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5621
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Country | US
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Telephone | 770-513-8922
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Fax | 770-513-0547
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Provider Business Mailing Address
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Address Line | 217 SCENIC HWY # 124
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5621
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Country | US
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Telephone | 770-513-8922
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Fax | 770-513-0547
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Authorized Official
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Title or Position | PROVIDOR PARTNER
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Name | JEANETTE ALTIERI
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Credential | DC
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Telephone | 770-513-8922
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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 | CHIR004727
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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 | CHIR004740
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License Number State | GA
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