Provider Demographics
NPI:1689892309
Name:ACTION CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ACTION CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENS
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-924-4700
Mailing Address - Street 1:4290 BELLS FERRY RD NW
Mailing Address - Street 2:SUITE #118
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7140
Mailing Address - Country:US
Mailing Address - Phone:770-924-4700
Mailing Address - Fax:770-924-4713
Practice Address - Street 1:4290 BELLS FERRY RD NW
Practice Address - Street 2:SUITE #118
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:770-924-4700
Practice Address - Fax:770-924-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU42719Medicare UPIN
GA35ZCCMWMedicare ID - Type Unspecified