Provider Demographics
NPI:1841461647
Name:INTEGRAL CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:INTEGRAL CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-233-3386
Mailing Address - Street 1:2255 CUMBERLAND PKWY SE
Mailing Address - Street 2:BLDG #900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4515
Mailing Address - Country:US
Mailing Address - Phone:404-233-3386
Mailing Address - Fax:404-233-3186
Practice Address - Street 1:2255 CUMBERLAND PKWY SE
Practice Address - Street 2:BLDG #900
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4515
Practice Address - Country:US
Practice Address - Phone:404-233-3386
Practice Address - Fax:404-233-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO7836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVO4170Medicare UPIN