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General NPI Number Information
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NPI Number | 1013450543
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Entity Type | Organization
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Legal Business Name | BORN AGAIN CHIROPRACTIC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 319 HOMESTEAD CIR NW
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City | KENNESAW
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State | GA
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Zip | 30144-1335
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Country | US
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Telephone | 787-548-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 319 HOMESTEAD CIR NW
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City | KENNESAW
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State | GA
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Zip | 30144-1335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASTRID PILAR CABRERA
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Credential | DC
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Telephone | 787-548-0427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR009646
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License Number State | GA
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