Provider Demographics
NPI:1477876589
Name:ABSOLUTE SPINE AND HEALTH
Entity Type:Organization
Organization Name:ABSOLUTE SPINE AND HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-437-3111
Mailing Address - Street 1:850 DOGWOOD RD
Mailing Address - Street 2:SUITE C500
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7218
Mailing Address - Country:US
Mailing Address - Phone:678-437-3111
Mailing Address - Fax:
Practice Address - Street 1:3071 HARRIS MILL CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4009
Practice Address - Country:US
Practice Address - Phone:678-437-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty