Provider Demographics
NPI:1689818981
Name:DOUGLAS SPINE AND REHAB
Entity Type:Organization
Organization Name:DOUGLAS SPINE AND REHAB
Other - Org Name:DOUGLAS SPINE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-384-4494
Mailing Address - Street 1:105 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2325
Mailing Address - Country:US
Mailing Address - Phone:912-384-4494
Mailing Address - Fax:
Practice Address - Street 1:105 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2325
Practice Address - Country:US
Practice Address - Phone:912-384-4494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty