Provider Demographics
NPI:1447486477
Name:ALIVE TOUCH HEALTH CENTER
Entity type:Organization
Organization Name:ALIVE TOUCH HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:FOURRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-345-7885
Mailing Address - Street 1:4080 HOLLY SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7410
Mailing Address - Country:US
Mailing Address - Phone:770-345-7885
Mailing Address - Fax:770-345-7883
Practice Address - Street 1:4080 HOLLY SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7410
Practice Address - Country:US
Practice Address - Phone:770-345-7885
Practice Address - Fax:770-345-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006079111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1972642296OtherINDIVIDUAL NPI
GA35ZCFVJOtherMEDICARE PART B
52726673OtherBLUE CROSS / BLUE SHIELD