Provider Demographics
NPI:1790005403
Name:WEST COBB HEALTH ADN REHAB CENTER
Entity type:Organization
Organization Name:WEST COBB HEALTH ADN REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAMPAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-699-3238
Mailing Address - Street 1:3901 MARY ELIZA TRCE NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1094
Mailing Address - Country:US
Mailing Address - Phone:770-485-3255
Mailing Address - Fax:770-693-7804
Practice Address - Street 1:3901 MARY ELIZA TRCE NW
Practice Address - Street 2:SUITE 202
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1094
Practice Address - Country:US
Practice Address - Phone:770-485-3255
Practice Address - Fax:770-693-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty