Provider Demographics
NPI:1548458326
Name:PIZZA CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:PIZZA CLINIC OF CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-761-6200
Mailing Address - Street 1:3284 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1158
Mailing Address - Country:US
Mailing Address - Phone:404-761-6200
Mailing Address - Fax:404-761-0825
Practice Address - Street 1:3284 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1158
Practice Address - Country:US
Practice Address - Phone:404-761-6200
Practice Address - Fax:404-761-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty