Provider Demographics
NPI:1497977938
Name:ALLIANCE HEALTH AND WELLNESS CENTER PC
Entity Type:Organization
Organization Name:ALLIANCE HEALTH AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-888-4600
Mailing Address - Street 1:233 ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2609
Mailing Address - Country:US
Mailing Address - Phone:770-888-4600
Mailing Address - Fax:770-888-4601
Practice Address - Street 1:233 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2609
Practice Address - Country:US
Practice Address - Phone:770-888-4600
Practice Address - Fax:770-888-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005583111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35CZDKXMedicare ID - Type Unspecified
GAU63036Medicare UPIN