Provider Demographics
NPI:1568767069
Name:SPINAL CHECK FOUNDATION LLC
Entity Type:Organization
Organization Name:SPINAL CHECK FOUNDATION LLC
Other - Org Name:SPINAL CHECK FOUNDATION LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-795-0453
Mailing Address - Street 1:2710 TOWN CENTER DR NW
Mailing Address - Street 2:STE 104
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4903
Mailing Address - Country:US
Mailing Address - Phone:770-795-0453
Mailing Address - Fax:770-795-0454
Practice Address - Street 1:2710 TOWN CENTER DR NW
Practice Address - Street 2:STE 104
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4903
Practice Address - Country:US
Practice Address - Phone:770-795-0453
Practice Address - Fax:770-795-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008556111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12075811Medicare PIN