Provider Demographics
NPI:1629018007
Name:ALL-PRO CHIROPRACTIC & PAIN SPECIALISTS
Entity Type:Organization
Organization Name:ALL-PRO CHIROPRACTIC & PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LOOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-985-5223
Mailing Address - Street 1:3035 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1806
Mailing Address - Country:US
Mailing Address - Phone:770-985-5223
Mailing Address - Fax:770-985-5590
Practice Address - Street 1:3035 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 7
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1806
Practice Address - Country:US
Practice Address - Phone:770-985-5223
Practice Address - Fax:770-985-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007718261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1780642504Medicare UPIN