1831387935 NPI number — CASEY FAMILY CHIROPRACTIC, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831387935 NPI number — CASEY FAMILY CHIROPRACTIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASEY FAMILY CHIROPRACTIC, PC
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:
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:
1831387935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5755 NORTH POINT PARKWAY
Provider Second Line Business Mailing Address:
SUITE 98
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30022-1152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-667-0091
Provider Business Mailing Address Fax Number:
770-783-6919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5755 NORTH POINT PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 98
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30022-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-667-0091
Provider Business Practice Location Address Fax Number:
770-783-6919
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASEY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
770-667-0091

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR005037 , 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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