Provider Demographics
NPI:1902977457
Name:LIGHT FORCE FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LIGHT FORCE FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-452-5433
Mailing Address - Street 1:680 DUNLAP RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-5405
Mailing Address - Country:US
Mailing Address - Phone:478-452-5433
Mailing Address - Fax:478-454-1929
Practice Address - Street 1:680 DUNLAP RD NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-5405
Practice Address - Country:US
Practice Address - Phone:478-452-5433
Practice Address - Fax:478-454-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2139643AH261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004064Medicare ID - Type Unspecified