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General NPI Number Information
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NPI Number | 1073720207
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Entity Type | Organization
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Legal Business Name | NORCROSS CHIROPRACTIC & PHYSICAL REHAB, LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5390 PEACHTREE INDUSTRIAL BLVD STE 120
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City | NORCROSS
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State | GA
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Zip | 30071-4715
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Country | US
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Telephone | 770-416-2225
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Fax | 770-416-2224
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Provider Business Mailing Address
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Address Line | 5390 PEACHTREE INDUSTRIAL BLVD STE 120
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City | NORCROSS
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State | GA
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Zip | 30071-4715
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Country | US
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Telephone | 770-416-2225
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Fax | 770-416-2224
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. JOSEPH C. DRUDA
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Credential | D.C.
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Telephone | 770-416-2225
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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 | 007257
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License Number State | GA
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