Provider Demographics
NPI:1346401775
Name:TAO CHIRO LLC
Entity Type:Organization
Organization Name:TAO CHIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/REGISTERED NURSE
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DINERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN DC
Authorized Official - Phone:404-378-6300
Mailing Address - Street 1:917 SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1303
Mailing Address - Country:US
Mailing Address - Phone:404-378-8978
Mailing Address - Fax:770-939-9353
Practice Address - Street 1:2545 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3239
Practice Address - Country:US
Practice Address - Phone:404-378-6300
Practice Address - Fax:770-939-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002592261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22510OtherMEDICARE # 35ZCFVL