=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063554855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMATO CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2475 VILLAGE DR SUITE 108
-----------------------------------------------------
City | KINGSLAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31548-6728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-882-8888
-----------------------------------------------------
Fax | 912-882-8889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2475 VILLAGE DR SUITE 108
-----------------------------------------------------
City | KINGSLAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31548-6728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-882-8888
-----------------------------------------------------
Fax | 912-882-8889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DAVID MATTHEW AMATO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 912-882-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR005559
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR005497
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------