Provider Demographics
NPI:1114396769
Name:PHYSICAL MEDICINE INJURY CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE INJURY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLABAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-956-2388
Mailing Address - Street 1:218 HIGHWAY 49 N
Mailing Address - Street 2:SUITE C
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008
Mailing Address - Country:US
Mailing Address - Phone:478-956-2388
Mailing Address - Fax:478-956-2389
Practice Address - Street 1:218 HIGHWAY 49 N
Practice Address - Street 2:SUITE C
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008
Practice Address - Country:US
Practice Address - Phone:478-956-2388
Practice Address - Fax:478-956-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty