Provider Demographics
NPI:1235303686
Name:ATLAS NECK & BACK CENTER
Entity Type:Organization
Organization Name:ATLAS NECK & BACK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-845-6999
Mailing Address - Street 1:309 N. MORGAN ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241
Mailing Address - Country:US
Mailing Address - Phone:706-845-6999
Mailing Address - Fax:706-845-6998
Practice Address - Street 1:309 N. MORGAN ST.
Practice Address - Street 2:SUITE A
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241
Practice Address - Country:US
Practice Address - Phone:706-845-6999
Practice Address - Fax:706-845-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7422Medicare PIN