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NPI Code Detail

MEDICARE: PROACTIVE HEALTH THERAPEUTIC SOLUTIONS, LLC

MEDICARE: PROACTIVE HEALTH THERAPEUTIC SOLUTIONS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCHIR008727GA

General Provider Information

NPI Number : 1366721474
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROACTIVE HEALTH THERAPEUTIC SOLUTIONS, LLC
Provider Business Mailing Address
First Line : 401 LAWTON AVE
Second Line :
City : SAVANNAH
State : GA
Zip : 31404-1743
Country : US
Telephone Number : 912-224-9581
Fax Number :
Provider Business Practice Location Address
First Line : 10 HARRELL DR
Second Line :
City : GARDEN CITY
State : GA
Zip : 31408-2005
Country : US
Telephone Number : 912-963-6711
Fax Number : 912-963-6713
Authorized Official
Title or Position : OWNER, CHIROPRACTOR
Name : DR. LAKEIA MONIQUE MANOR
Credential : D.C.
Telephone Number : 912-224-9581
Provider Enumeration Date : 08/06/2011
Last Update Date : 08/06/2011

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Directions to “PROACTIVE HEALTH THERAPEUTIC SOLUTIONS, LLC ” Practice Location

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