Provider Demographics
NPI:1801032651
Name:NEO CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:NEO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIKWANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-418-2340
Mailing Address - Street 1:10900 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1503
Mailing Address - Country:US
Mailing Address - Phone:770-418-2340
Mailing Address - Fax:770-418-1455
Practice Address - Street 1:10900 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1503
Practice Address - Country:US
Practice Address - Phone:770-418-2340
Practice Address - Fax:770-418-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty