Provider Demographics
NPI:1144589433
Name:PARK RIDGE CHIROPRACTIC CENTRE
Entity Type:Organization
Organization Name:PARK RIDGE CHIROPRACTIC CENTRE
Other - Org Name:PARK RIDGE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SALLARULO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-457-0584
Mailing Address - Street 1:2896 CHAMBLEE TUCKER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4009
Mailing Address - Country:US
Mailing Address - Phone:770-457-0584
Mailing Address - Fax:770-457-0773
Practice Address - Street 1:2896 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4009
Practice Address - Country:US
Practice Address - Phone:770-457-0584
Practice Address - Fax:770-457-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty