Provider Demographics
NPI:1295865608
Name:ADVANCED CHIROPRACTIC REHABILITATION
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC REHABILITATION
Other - Org Name:BACK WELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-421-8900
Mailing Address - Street 1:1115 POWDER SPRINGS RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5268
Mailing Address - Country:US
Mailing Address - Phone:770-421-8900
Mailing Address - Fax:770-422-6636
Practice Address - Street 1:1115 POWDER SPRINGS RD
Practice Address - Street 2:SUITE M
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5268
Practice Address - Country:US
Practice Address - Phone:770-421-8900
Practice Address - Fax:770-422-6636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED CHIROPRACTIC REHABILITATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty