Provider Demographics
NPI:1346023512
Name:SPINEALIGN PC
Entity Type:Organization
Organization Name:SPINEALIGN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRA
Authorized Official - Middle Name:MAELETTE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-455-3654
Mailing Address - Street 1:140 CARNEGIE PL STE 106
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7911
Mailing Address - Country:US
Mailing Address - Phone:404-455-3654
Mailing Address - Fax:
Practice Address - Street 1:140 CARNEGIE PL STE 106
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7911
Practice Address - Country:US
Practice Address - Phone:678-489-2974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty