Provider Demographics
NPI:1861904450
Name:HAPPY SPINE HEALTHY LIFE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:HAPPY SPINE HEALTHY LIFE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MCKENZIE
Authorized Official - Last Name:BOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-595-4320
Mailing Address - Street 1:953 PORT WEST DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-4607
Mailing Address - Country:US
Mailing Address - Phone:678-595-4320
Mailing Address - Fax:
Practice Address - Street 1:4530 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5412
Practice Address - Country:US
Practice Address - Phone:770-271-8949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1912418955Medicaid