Provider Demographics
NPI:1538318282
Name:DISCOVER REHABILITATION, INC
Entity Type:Organization
Organization Name:DISCOVER REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-516-9900
Mailing Address - Street 1:3940 CHEROKEE ST NW
Mailing Address - Street 2:SUITE 402
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6421
Mailing Address - Country:US
Mailing Address - Phone:770-423-9010
Mailing Address - Fax:770-423-9010
Practice Address - Street 1:2295 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5520
Practice Address - Country:US
Practice Address - Phone:770-516-9900
Practice Address - Fax:770-516-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCGCSOtherMEDICARE IDENTIFICATION NUMBER
1841392735OtherNPI