Provider Demographics
NPI:1154650497
Name:SPINAL HEALTH & REHAB DEVELOPMENT CORP.
Entity Type:Organization
Organization Name:SPINAL HEALTH & REHAB DEVELOPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-456-9122
Mailing Address - Street 1:2360 BETHELVIEW RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1306
Mailing Address - Country:US
Mailing Address - Phone:678-456-9122
Mailing Address - Fax:678-456-9125
Practice Address - Street 1:2360 BETHELVIEW RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1306
Practice Address - Country:US
Practice Address - Phone:678-456-9122
Practice Address - Fax:678-456-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700389OtherMEDICARE