Provider Demographics
NPI:1215508148
Name:PAIN AND ACCIDENT CHIROPRACTIC-ROSWELL LLC
Entity type:Organization
Organization Name:PAIN AND ACCIDENT CHIROPRACTIC-ROSWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-403-5689
Mailing Address - Street 1:425 E CROSSVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3058
Mailing Address - Country:US
Mailing Address - Phone:404-403-5689
Mailing Address - Fax:
Practice Address - Street 1:425 E CROSSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3058
Practice Address - Country:US
Practice Address - Phone:404-403-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center