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General NPI Number Information
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NPI Number | 1043587280
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Entity Type | Organization
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Legal Business Name | MARCECA CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 123 ELLIS RD SUITE A
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1842
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Country | US
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Telephone | 770-461-7664
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Fax | 770-461-1676
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Provider Business Mailing Address
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Address Line | 123 ELLIS RD SUITE A
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1842
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Country | US
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Telephone | 770-461-7664
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Fax | 770-461-1676
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL AL MARCECA
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Credential | D.O.
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Telephone | 770-461-7664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | CHIR002314
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License Number State | GA
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