Provider Demographics
NPI:1477361830
Name:MIRACLE CHIROPRACTIC REHAB & WELLNESS
Entity type:Organization
Organization Name:MIRACLE CHIROPRACTIC REHAB & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-731-1114
Mailing Address - Street 1:6853 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7179
Mailing Address - Country:US
Mailing Address - Phone:770-731-1114
Mailing Address - Fax:404-682-1396
Practice Address - Street 1:6853 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7179
Practice Address - Country:US
Practice Address - Phone:770-731-1114
Practice Address - Fax:404-682-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty