Healthcare Provider Details

I. General information

NPI: 1770801037
Provider Name (Legal Business Name): TRANSITION CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 WOODSTOCK RD SUITE 100
ROSWELL GA
30075-2367
US

IV. Provider business mailing address

1745 WOODSTOCK RD SUITE 100
ROSWELL GA
30075-2367
US

V. Phone/Fax

Practice location:
  • Phone: 678-665-0455
  • Fax: 770-643-0060
Mailing address:
  • Phone: 678-665-0455
  • Fax: 770-643-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number008364
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JASON A REGIS
Title or Position: OWNER
Credential: DC PT
Phone: 678-665-0455