Provider Demographics
NPI:1174973929
Name:HEALTHY LIFE CHIROPRACTIC INC
Entity type:Organization
Organization Name:HEALTHY LIFE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINA
Authorized Official - Middle Name:ZAIRE
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-252-3661
Mailing Address - Street 1:2753 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2316
Mailing Address - Country:US
Mailing Address - Phone:770-252-3661
Mailing Address - Fax:770-252-9598
Practice Address - Street 1:2753 HIGHWAY 34 E
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2316
Practice Address - Country:US
Practice Address - Phone:770-252-3661
Practice Address - Fax:770-252-9598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU81579Medicare UPIN