Healthcare Provider Details

I. General information

NPI: 1841831500
Provider Name (Legal Business Name): CHIRO ONSITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 JOSEPH E LOWERY BLVD NW STE 102
ATLANTA GA
30318-5286
US

IV. Provider business mailing address

3031 LIBERTY WAY NW
ATLANTA GA
30318-9388
US

V. Phone/Fax

Practice location:
  • Phone: 404-919-7404
  • Fax:
Mailing address:
  • Phone: 404-919-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMED HASANAIN
Title or Position: PRESIDENT
Credential: DC, MS
Phone: 404-919-7404