Provider Demographics
NPI:1669016143
Name:ATLANTA UPPER CERVICAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ATLANTA UPPER CERVICAL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAXTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:470-347-3737
Mailing Address - Street 1:125 E TRINITY PLACE
Mailing Address - Street 2:SUITE #247
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:470-347-3737
Mailing Address - Fax:470-347-3738
Practice Address - Street 1:125 E TRINITY PLACE
Practice Address - Street 2:SUITE #247
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:470-347-3737
Practice Address - Fax:470-347-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty