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General NPI Number Information
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NPI Number | 1306672902
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Entity Type | Organization
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Legal Business Name | ALLIANCE SPINE AND PHYSICAL MEDICINE
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 12045 HIGHWAY 92
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City | WOODSTOCK
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State | GA
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Zip | 30188-4499
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Country | US
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Telephone | 404-934-7367
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WATERS EDGE DR
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City | WOODSTOCK
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State | GA
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Zip | 30188-5695
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Country | US
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Telephone | 404-934-7367
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ZOELLER
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Credential |
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Telephone | 678-469-6939
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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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