Provider Demographics
NPI:1073720207
Name:NORCROSS CHIROPRACTIC & PHYSICAL REHAB, LLC
Entity Type:Organization
Organization Name:NORCROSS CHIROPRACTIC & PHYSICAL REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:DRUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-416-2225
Mailing Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4715
Mailing Address - Country:US
Mailing Address - Phone:770-416-2225
Mailing Address - Fax:770-416-2224
Practice Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 120
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4715
Practice Address - Country:US
Practice Address - Phone:770-416-2225
Practice Address - Fax:770-416-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty