Provider Demographics
NPI:1073872388
Name:EAST COBB WELLNESS CENTER
Entity Type:Organization
Organization Name:EAST COBB WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-565-2313
Mailing Address - Street 1:736 JOHNSON FERRY RD.
Mailing Address - Street 2:C-130
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-565-2313
Mailing Address - Fax:770-565-8733
Practice Address - Street 1:736 JOHNSON FERRY RD.
Practice Address - Street 2:C-130
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-565-2313
Practice Address - Fax:770-565-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty