1902108467 NPI number — MONROE SPORTS AND FAMILY CHIROPRACTIC,INC

Table of content: MICHAEL BRANDON ROGERS LCSW (NPI 1841553286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902108467 NPI number — MONROE SPORTS AND FAMILY CHIROPRACTIC,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE SPORTS AND FAMILY CHIROPRACTIC,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902108467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1658
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30655-6658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-207-5454
Provider Business Mailing Address Fax Number:
770-207-9465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 ALCOVY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30655-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-207-5454
Provider Business Practice Location Address Fax Number:
770-207-9465
Provider Enumeration Date:
12/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCHRAUB
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-207-5454

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  CHIR006524 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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