Provider Demographics
NPI:1700113453
Name:ADVANCED REHAB SOLUTIONS
Entity type:Organization
Organization Name:ADVANCED REHAB SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-817-0833
Mailing Address - Street 1:1180 MCKENDREE CHURCH RD
Mailing Address - Street 2:STE 202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5207
Mailing Address - Country:US
Mailing Address - Phone:770-817-0833
Mailing Address - Fax:770-817-0832
Practice Address - Street 1:1180 MCKENDREE CHURCH RD
Practice Address - Street 2:STE 202
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5207
Practice Address - Country:US
Practice Address - Phone:770-817-0833
Practice Address - Fax:770-817-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty