Organization
SPORTS PERFORMANCE CONCEPTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN ASHLEY CORTJENS DC, CCSP, QME, IIE (OWNER)
(470) 239-0770
Entity
Organization
Contact information
Practice address
3985 LAKEFIELD CT STE 206, SUWANEE, GA 30024-1209
(470) 239-0770
Mailing address
3985 LAKEFIELD CT STE 206, SUWANEE, GA 30024-1209
(470) 239-0770
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
CHIR009018
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063760635
TYPE I NPI
GA
01
—
1467144220
TYPE 1 NPI FOR IR
GA
01
—
1518380938
TYPE 2 NPI
GA
Enumeration date
02/05/2014
Last updated
08/31/2023
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