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General NPI Number Information
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NPI Number | 1295943967
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Entity Type | Organization
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Legal Business Name | COMPLETE BACK AND BODY CARE, INC.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1260 HIGHWAY 85 N
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7315
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Country | US
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Telephone | 770-719-9166
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Fax | 770-719-9136
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Provider Business Mailing Address
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Address Line | 1260 HIGHWAY 85 N
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7315
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Country | US
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Telephone | 770-719-9166
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Fax | 770-719-9136
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PATRICIA C. LASALATA
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Credential |
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Telephone | 770-719-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIRO07601
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License Number State | GA
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