Provider Demographics
NPI:1366182438
Name:ATLANTA CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:ATLANTA CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-224-1731
Mailing Address - Street 1:2053 STANTON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-1311
Mailing Address - Country:US
Mailing Address - Phone:404-698-3682
Mailing Address - Fax:833-623-4907
Practice Address - Street 1:2053 STANTON RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-1311
Practice Address - Country:US
Practice Address - Phone:404-698-3682
Practice Address - Fax:833-623-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty