Healthcare Provider Details

I. General information

NPI: 1235515958
Provider Name (Legal Business Name): WHOLE BODY CONCEPT CHIROPRATIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 SNAPFINGER WOODS DR SUITE 210
DECATUR GA
30035-3417
US

IV. Provider business mailing address

4150 SNAPFINGER WOODS DR SUITE 210
DECATUR GA
30035-3417
US

V. Phone/Fax

Practice location:
  • Phone: 678-392-6867
  • Fax: 855-218-7881
Mailing address:
  • Phone: 678-392-6867
  • Fax: 855-218-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008778
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR008778
License Number StateGA

VIII. Authorized Official

Name: MS. COURTNEY ACRE
Title or Position: OWNER
Credential: D C
Phone: 678-392-6867