Provider Demographics
NPI:1528413085
Name:OPTIMAL SPINAL REHAB
Entity Type:Organization
Organization Name:OPTIMAL SPINAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-499-9300
Mailing Address - Street 1:4284 MEMORIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1220
Mailing Address - Country:US
Mailing Address - Phone:404-499-9300
Mailing Address - Fax:404-499-9400
Practice Address - Street 1:4284 MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1220
Practice Address - Country:US
Practice Address - Phone:404-499-9300
Practice Address - Fax:404-499-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty