Healthcare Provider Details

I. General information

NPI: 1467584359
Provider Name (Legal Business Name): SOFT TISSUE AND CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 PEACHTREE RD NW SUITE 3
ATLANTA GA
30305-2296
US

IV. Provider business mailing address

3050 PEACHTREE RD NW SUITE 3
ATLANTA GA
30305-2296
US

V. Phone/Fax

Practice location:
  • Phone: 404-467-1278
  • Fax: 404-467-1178
Mailing address:
  • Phone: 404-467-1278
  • Fax: 404-467-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR006237
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID RADASZEWSKI
Title or Position: CHIROPRACTOR OWNER
Credential: DO
Phone: 404-467-1278