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General NPI Number Information
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NPI Number | 1316550064
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE OF EAST COBB
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 4260 SHALLOWFORD RD
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City | MARIETTA
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State | GA
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Zip | 30062-5011
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Country | US
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Telephone | 770-998-8599
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Fax | 770-998-9499
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Provider Business Mailing Address
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Address Line | 198 WINN ST NW
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City | MARIETTA
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State | GA
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Zip | 30064-2256
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Country | US
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Telephone | 678-472-6262
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Fax | 770-428-4956
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRENT ALAN BRUMBAUGH
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Credential | DC
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Telephone | 672-472-6262
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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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