Provider Demographics
NPI:1821242785
Name:EAST-WEST SPINE AND REHAB CLINIC INC.
Entity Type:Organization
Organization Name:EAST-WEST SPINE AND REHAB CLINIC INC.
Other - Org Name:PROADJUSTER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARARAT
Authorized Official - Middle Name:MUSHEGAN
Authorized Official - Last Name:LEGUIZAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-656-0203
Mailing Address - Street 1:1385 HIGHLANDS RIDGE RD SE STE C
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4894
Mailing Address - Country:US
Mailing Address - Phone:770-432-5600
Mailing Address - Fax:770-432-5602
Practice Address - Street 1:1385 HIGHLANDS RIDGE RD SE
Practice Address - Street 2:SUITE C
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4893
Practice Address - Country:US
Practice Address - Phone:770-432-5600
Practice Address - Fax:770-432-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008391305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service