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General NPI Number Information
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NPI Number | 1841802014
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Entity Type | Organization
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Legal Business Name | LOST MOUNTAIN CHIROPRACTIC FAMILY AND PEDIATRICS LLC
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 1685 MARS HILL RD NW STE 103
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City | ACWORTH
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State | GA
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Zip | 30101-7180
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Country | US
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Telephone | 770-218-0400
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Fax | 770-218-1160
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Provider Business Mailing Address
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Address Line | 1685 MARS HILL RD NW STE 103
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City | ACWORTH
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State | GA
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Zip | 30101-7180
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Country | US
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Telephone | 770-218-0400
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Fax | 770-218-1160
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRENNA RENEE RODEN
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Credential | DC
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Telephone | 770-218-0400
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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 |
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License Number State |
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