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General NPI Number Information
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NPI Number | 1851833255
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Entity Type | Organization
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Legal Business Name | PILLAR CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 3901 MARY ELIZA TRCE NW SUITE 201
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City | MARIETTA
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State | GA
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Zip | 30064-1094
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Country | US
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Telephone | 770-765-3640
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 MARY ELIZA TRCE NW SUITE 201
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City | MARIETTA
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State | GA
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Zip | 30064-1094
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Country | US
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Telephone | 770-765-3640
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. SHANNON MARTIN
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Credential | D.C.
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Telephone | 770-765-3640
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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 | CHIR009791
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License Number State | GA
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