Provider Demographics
NPI:1295943967
Name:COMPLETE BACK AND BODY CARE, INC.
Entity type:Organization
Organization Name:COMPLETE BACK AND BODY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LASALATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-719-9166
Mailing Address - Street 1:1260 HIGHWAY 85 N
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7315
Mailing Address - Country:US
Mailing Address - Phone:770-719-9166
Mailing Address - Fax:770-719-9136
Practice Address - Street 1:1260 HIGHWAY 85 N
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7315
Practice Address - Country:US
Practice Address - Phone:770-719-9166
Practice Address - Fax:770-719-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07601111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty