Provider Demographics
NPI:1386179505
Name:INNOVA BRAIN REHABILITATION
Entity Type:Organization
Organization Name:INNOVA BRAIN REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB, FABBIR
Authorized Official - Phone:770-485-6554
Mailing Address - Street 1:200 COBB PKWY N
Mailing Address - Street 2:SUITE 128
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3585
Mailing Address - Country:US
Mailing Address - Phone:770-485-6554
Mailing Address - Fax:
Practice Address - Street 1:200 COBB PKWY N
Practice Address - Street 2:SUITE 128
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3585
Practice Address - Country:US
Practice Address - Phone:770-485-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005136111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty