Organization
DIRTY BOOTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA HOLS DC (OWNER)
(515) 422-0171
Entity
Organization
Contact information
Practice address
252 HICKS DR SE, MARIETTA, GA 30060-3408
(515) 422-0171
Mailing address
252 HICKS DR SE, MARIETTA, GA 30060-3408
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR009627
GA
Other
Enumeration date
01/20/2016
Last updated
01/20/2016
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