Provider Demographics
NPI:1790845824
Name:SPINE CARE CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:SPINE CARE CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-957-4165
Mailing Address - Street 1:130 JOHN FRANK WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3207
Mailing Address - Country:US
Mailing Address - Phone:770-957-4165
Mailing Address - Fax:770-957-2003
Practice Address - Street 1:130 JOHN FRANK WARD BLVD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3207
Practice Address - Country:US
Practice Address - Phone:770-957-4165
Practice Address - Fax:770-957-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA7894OtherRAILROAD MEDICARE
GAGRP6282Medicare ID - Type Unspecified