Healthcare Provider Details

I. General information

NPI: 1821143298
Provider Name (Legal Business Name): ORTHO-NEURO CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 CHURCH ST
DECATUR GA
30030-1519
US

IV. Provider business mailing address

1376 CHURCH ST
DECATUR GA
30030-1519
US

V. Phone/Fax

Practice location:
  • Phone: 404-373-0400
  • Fax:
Mailing address:
  • Phone: 404-373-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number031958
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number031958
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3002
License Number StateGA

VIII. Authorized Official

Name: DR. JOON WHEE KIM
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 404-373-0400