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General NPI Number Information
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NPI Number | 1881169456
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Entity Type | Organization
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Legal Business Name | LEGACY CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 4073 LAVISTA RD STE 371
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City | TUCKER
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State | GA
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Zip | 30084-5221
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Country | US
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Telephone | 770-376-5784
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Fax | 770-376-5789
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Provider Business Mailing Address
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Address Line | 4073 LAVISTA RD STE 371
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City | TUCKER
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State | GA
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Zip | 30084-5221
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Country | US
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Telephone | 770-376-5784
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Fax | 770-376-5789
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Authorized Official
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Title or Position | CEO/CHIROPRACTOR
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Name | DR. JESSICA HARRIS
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Credential | DC
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Telephone | 770-376-5784
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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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