Provider Demographics
NPI:1902108467
Name:MONROE SPORTS AND FAMILY CHIROPRACTIC,INC
Entity Type:Organization
Organization Name:MONROE SPORTS AND FAMILY CHIROPRACTIC,INC
Other - Org Name:ALCOVY SPORTS AND FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-207-5454
Mailing Address - Street 1:PO BOX 1658
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-6658
Mailing Address - Country:US
Mailing Address - Phone:770-207-5454
Mailing Address - Fax:770-207-9465
Practice Address - Street 1:311 ALCOVY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2139
Practice Address - Country:US
Practice Address - Phone:770-207-5454
Practice Address - Fax:770-207-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006524261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU73958Medicare UPIN