Provider Demographics
NPI:1013265479
Name:AC SPINE & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:AC SPINE & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-513-8922
Mailing Address - Street 1:217 SCENIC HWY # 124
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5621
Mailing Address - Country:US
Mailing Address - Phone:770-513-8922
Mailing Address - Fax:770-513-0547
Practice Address - Street 1:217 SCENIC HWY # 124
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5621
Practice Address - Country:US
Practice Address - Phone:770-513-8922
Practice Address - Fax:770-513-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty