Provider Demographics
NPI:1972924686
Name:ATLANTA CENTER FOR PAIN, INJURY & REHAB, LLC
Entity Type:Organization
Organization Name:ATLANTA CENTER FOR PAIN, INJURY & REHAB, LLC
Other - Org Name:ACPIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR-CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-465-7092
Mailing Address - Street 1:2400 PLEASANT HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4398
Mailing Address - Country:US
Mailing Address - Phone:678-465-7092
Mailing Address - Fax:678-832-1528
Practice Address - Street 1:2400 PLEASANT HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4398
Practice Address - Country:US
Practice Address - Phone:678-465-7092
Practice Address - Fax:678-832-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty