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General NPI Number Information
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NPI Number | 1225650435
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Entity Type | Organization
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Legal Business Name | ICEBERG HOLDINGS LLC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 1670 MCKENDREE CHURCH RD STE 400B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4100
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Country | US
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Telephone | 678-985-0444
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Fax | 470-823-9759
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Provider Business Mailing Address
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Address Line | 1670 MCKENDREE CHURCH RD STE 400B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4100
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Country | US
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Telephone | 678-985-0444
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | KAMLESH PATEL
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Credential | DC
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Telephone | 678-985-0444
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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 |
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License Number State |
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