Provider Demographics
NPI:1831385384
Name:COMPLETE HEALTH CHIROPRACTIC AND REHAB CENTER
Entity type:Organization
Organization Name:COMPLETE HEALTH CHIROPRACTIC AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:VIRGILIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-546-8044
Mailing Address - Street 1:3280 HAMILTON MILL RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4003
Mailing Address - Country:US
Mailing Address - Phone:678-546-8044
Mailing Address - Fax:678-546-8047
Practice Address - Street 1:3280 HAMILTON MILL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4003
Practice Address - Country:US
Practice Address - Phone:678-546-8044
Practice Address - Fax:678-546-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6096OtherMEDICARE GROUP NUMBER