Provider Demographics
NPI:1801028287
Name:TEAM CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:TEAM CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DIMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-402-1091
Mailing Address - Street 1:10175 DALLAS ACWORTH HWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-9300
Mailing Address - Country:US
Mailing Address - Phone:678-402-1091
Mailing Address - Fax:
Practice Address - Street 1:10175 DALLAS ACWORTH HWY
Practice Address - Street 2:SUITE 119
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-9300
Practice Address - Country:US
Practice Address - Phone:678-402-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007600111N00000X
GA007609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty