Provider Demographics
NPI:1245419274
Name:COMPLETE SPINE SOLUTIONS, PC
Entity Type:Organization
Organization Name:COMPLETE SPINE SOLUTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-938-4606
Mailing Address - Street 1:2347 BROCKETT RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4474
Mailing Address - Country:US
Mailing Address - Phone:770-938-4606
Mailing Address - Fax:404-231-9953
Practice Address - Street 1:2347 BROCKETT RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4474
Practice Address - Country:US
Practice Address - Phone:770-938-4606
Practice Address - Fax:404-231-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4620OtherMEDICARE GROUP NUMBER
GAU69031Medicare UPIN