Provider Demographics
NPI:1548495351
Name:ANDREONE SPORTS & FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:ANDREONE SPORTS & FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ANDREONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-486-7576
Mailing Address - Street 1:404 STEVENS ENTRY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4050
Mailing Address - Country:US
Mailing Address - Phone:770-486-7576
Mailing Address - Fax:770-486-7564
Practice Address - Street 1:404 STEVENS ENTRY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4050
Practice Address - Country:US
Practice Address - Phone:770-486-7576
Practice Address - Fax:770-486-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHFPMedicare UPIN