Provider Demographics
NPI:1558684720
Name:ADVANCED SPINAL REHAB CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED SPINAL REHAB CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:ABINIDI
Authorized Official - Last Name:TOLMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:229-432-0012
Mailing Address - Street 1:1903 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1574
Mailing Address - Country:US
Mailing Address - Phone:229-432-0012
Mailing Address - Fax:229-432-9922
Practice Address - Street 1:1903 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1574
Practice Address - Country:US
Practice Address - Phone:229-432-0012
Practice Address - Fax:229-432-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty