Provider Demographics
NPI:1861750119
Name:MARIETTA FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:MARIETTA FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-323-9169
Mailing Address - Street 1:231 CRESCENT CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3239
Mailing Address - Country:US
Mailing Address - Phone:678-323-9169
Mailing Address - Fax:
Practice Address - Street 1:231 CRESCENT CIR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3239
Practice Address - Country:US
Practice Address - Phone:678-323-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008521111N00000X
GACHIR008786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty