Provider Demographics
NPI:1467584359
Name:SOFT TISSUE AND CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SOFT TISSUE AND CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RADASZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-467-1278
Mailing Address - Street 1:3050 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2296
Mailing Address - Country:US
Mailing Address - Phone:404-467-1278
Mailing Address - Fax:404-467-1178
Practice Address - Street 1:3050 PEACHTREE RD NW
Practice Address - Street 2:SUITE 3
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2296
Practice Address - Country:US
Practice Address - Phone:404-467-1278
Practice Address - Fax:404-467-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006237111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER