Provider Demographics
NPI:1548701238
Name:SUWANEE HAPPY CHIROPRACTIC
Entity type:Organization
Organization Name:SUWANEE HAPPY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONGWOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-765-8073
Mailing Address - Street 1:686 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3043
Mailing Address - Country:US
Mailing Address - Phone:678-765-8073
Mailing Address - Fax:678-765-8074
Practice Address - Street 1:686 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3043
Practice Address - Country:US
Practice Address - Phone:678-765-8073
Practice Address - Fax:678-765-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty