Provider Demographics
NPI:1497268494
Name:SPINEALIGN CENTER LLC
Entity Type:Organization
Organization Name:SPINEALIGN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-974-5462
Mailing Address - Street 1:1195 FAIRBURN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2150
Mailing Address - Country:US
Mailing Address - Phone:678-974-5462
Mailing Address - Fax:
Practice Address - Street 1:1195 FAIRBURN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2150
Practice Address - Country:US
Practice Address - Phone:678-974-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty